Datesh Daneshwar et al., 2024: Stem cell assisted low-intensity shockwave for erectile dysfunction treatment: Current perspective

Tuesday, 04 February 2025

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Datesh Daneshwar 1, Yemin Lee 2, Abid Nordin 3
1Urology Clinic, Prince Court Medical Centre, 39, Jalan Kia Peng, Kuala Lumpur 50450, Malaysia.
2MedCentral Consulting, International Youth Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
3Graduate School of Medicine, KPJ Healthcare University, Nilai 71800, Negeri Sembilan, Malaysia.

Abstract

Stem cell therapy and low-intensity extracorporeal shockwave (LI-ECSW) are recognized as potential restorative therapies and have been used in the treatment of erectile dysfunction (ED). Stem cell therapy is well-known due to its attributed regenerative ability and thus can help to improve erectile function in patients with vasculogenic ED. Besides, current evidence also shows that LI-ECSW therapy can help stimulate cell recruitment and proliferation and promote angiogenesis and vascularization in the damaged tissue. Hence, due to the therapeutic and restorative effects of both therapies, the success of ED treatment can be elevated through a combination therapy between stem cell therapy and LI-ECSW. In this review, a detailed description and efficacy discussion of combination therapies between different types of stem cells and LI-ECSW therapy are described. Besides, other potential cell types to use together with LI-ECSW are also listed in this review. Thus, this review provides better insight on the efficacy of combination therapy for ED treatment.

Regen Ther. 2024 Nov 20:26:1150-1158. doi: 10.1016/j.reth.2024.11.006. eCollection 2024 Jun.
PMID: 39640922 PMCID: PMC11617694

Comments 1

Jens Rassweiler on Tuesday, 04 February 2025 10:00

The article discusses the combined use of stem cell therapy and low-intensity extracorporeal shockwave therapy (LI-ESWT) for the treatment of erectile dysfunction (ED). It highlights the prevalence of ED and the limitations of traditional treatments such as phosphodiesterase type-5 inhibitors (PDE5i) and intracavernosal injections, which can be ineffective for some patients or lead to adverse effects. The article emphasizes the need for less invasive restorative therapies that focus on repairing or replacing damaged erectile tissue.

Stem cell therapy is presented as a promising option due to the regenerative capabilities of stem cells, which can secrete growth factors and promote tissue repair. The article reviews various studies that show the efficacy of combining stem cell therapy, particularly adipose-derived stem cells (ADSC) and mesenchymal stem cells (MSC), with LI-ESWT). This combination enhances the therapeutic effects of both treatments, improving erectile function in animal models and showing potential for human applications.

Low-intensity extracorporeal shockwave therapy (LI-ESWT) and stem cell therapy each utilize distinct mechanisms to promote tissue repair and regeneration, particularly in the context of erectile dysfunction (ED).

Mechanisms of LI-ESWT:
1. Mechanical Stimulation: LI-ESWT applies low-intensity shockwaves that create microtrauma in the targeted tissue. This mechanical stimulation induces a biological response characterized by the release of growth factors and cytokines.

2. Angiogenesis: The shockwaves encourage the formation of new blood vessels (angiogenesis) by stimulating endothelial cells and promoting the expression of vascular endothelial growth factor (VEGF). This improved blood flow is crucial for restoring erectile function.

3. Tissue Regeneration: LI-ESWT has been shown to enhance the recruitment and proliferation of stem cells to the treatment area, improving the regenerative capacity of the tissue. It also promotes nerve regeneration through the activation of pathways that support cell survival and growth.

Mechanisms of Stem Cell Therapy:
1. Regenerative Potential: Stem cells possess the ability to self-renew and differentiate into various cell types, including smooth muscle and endothelial cells. This is critical for repairing damaged erectile tissue.

2. Secretion of Growth Factors: Stem cells secrete a variety of growth factors, cytokines, and chemokines that facilitate tissue healing, reduce inflammation, and promote angiogenesis.

3. Paracrine Effects: Stem cells exert their effects not only through direct differentiation but also through paracrine signaling, where they release soluble factors that influence neighboring cells, enhancing their survival and function.

Combined Mechanisms: When used together, LI-ESWT and stem cell therapy create a synergistic effect. LI-ESWT enhances the mobilization and effectiveness of stem cells, improving their ability to reach and repair the damaged erectile tissue. The mechanical stimulation from LI-ESWT can also help to optimize the environment for stem cell function, thereby amplifying the overall therapeutic effect on erectile function.

The review also discusses the mechanisms through which LI-ESWT promotes tissue regeneration and the recruitment of stem cells to the affected areas. While the combination therapy shows promise, the article points out existing knowledge gaps and the need for further research to understand the long-term effects and optimize treatment protocols.

Additionally, it mentions the regulatory challenges faced by such therapies, as they have not yet received FDA approval for ED treatment, though they are recognized by the European Association of Urology (EAU).

Jens Rassweiler

Stem cell therapy is presented as a promising option due to the regenerative capabilities of stem cells, which can secrete growth factors and promote tissue repair. The article reviews various studies that show the efficacy of combining stem cell therapy, particularly adipose-derived stem cells (ADSC) and mesenchymal stem cells (MSC), with LI-ESWT). This combination enhances the therapeutic effects of both treatments, improving erectile function in animal models and showing potential for human applications.

Low-intensity extracorporeal shockwave therapy (LI-ESWT) and stem cell therapy each utilize distinct mechanisms to promote tissue repair and regeneration, particularly in the context of erectile dysfunction (ED).

Mechanisms of LI-ESWT:
1.	Mechanical Stimulation: LI-ESWT applies low-intensity shockwaves that create microtrauma in the targeted tissue. This mechanical stimulation induces a biological response characterized by the release of growth factors and cytokines.

2.	Angiogenesis: The shockwaves encourage the formation of new blood vessels (angiogenesis) by stimulating endothelial cells and promoting the expression of vascular endothelial growth factor (VEGF). This improved blood flow is crucial for restoring erectile function.

3.	Tissue Regeneration: LI-ESWT has been shown to enhance the recruitment and proliferation of stem cells to the treatment area, improving the regenerative capacity of the tissue. It also promotes nerve regeneration through the activation of pathways that support cell survival and growth.

Mechanisms of Stem Cell Therapy:
1.	Regenerative Potential: Stem cells possess the ability to self-renew and differentiate into various cell types, including smooth muscle and endothelial cells. This is critical for repairing damaged erectile tissue.

2.	Secretion of Growth Factors: Stem cells secrete a variety of growth factors, cytokines, and chemokines that facilitate tissue healing, reduce inflammation, and promote angiogenesis.

3.	Paracrine Effects: Stem cells exert their effects not only through direct differentiation but also through paracrine signaling, where they release soluble factors that influence neighboring cells, enhancing their survival and function.

Combined Mechanisms: When used together, LI-ESWT and stem cell therapy create a synergistic effect. LI-ESWT enhances the mobilization and effectiveness of stem cells, improving their ability to reach and repair the damaged erectile tissue. The mechanical stimulation from LI-ESWT can also help to optimize the environment for stem cell function, thereby amplifying the overall therapeutic effect on erectile function.

The review also discusses the mechanisms through which LI-ESWT promotes tissue regeneration and the recruitment of stem cells to the affected areas. While the combination therapy shows promise, the article points out existing knowledge gaps and the need for further research to understand the long-term effects and optimize treatment protocols.

Additionally, it mentions the regulatory challenges faced by such therapies, as they have not yet received FDA approval for ED treatment, though they are recognized by the European Association of Urology (EAU).

Jens Rassweiler

The article discusses the combined use of stem cell therapy and low-intensity extracorporeal shockwave therapy (LI-ESWT) for the treatment of erectile dysfunction (ED). It highlights the prevalence of ED and the limitations of traditional treatments such as phosphodiesterase type-5 inhibitors (PDE5i) and intracavernosal injections, which can be ineffective for some patients or lead to adverse effects. The article emphasizes the need for less invasive restorative therapies that focus on repairing or replacing damaged erectile tissue. Stem cell therapy is presented as a promising option due to the regenerative capabilities of stem cells, which can secrete growth factors and promote tissue repair. The article reviews various studies that show the efficacy of combining stem cell therapy, particularly adipose-derived stem cells (ADSC) and mesenchymal stem cells (MSC), with LI-ESWT). This combination enhances the therapeutic effects of both treatments, improving erectile function in animal models and showing potential for human applications. Low-intensity extracorporeal shockwave therapy (LI-ESWT) and stem cell therapy each utilize distinct mechanisms to promote tissue repair and regeneration, particularly in the context of erectile dysfunction (ED). Mechanisms of LI-ESWT: 1. Mechanical Stimulation: LI-ESWT applies low-intensity shockwaves that create microtrauma in the targeted tissue. This mechanical stimulation induces a biological response characterized by the release of growth factors and cytokines. 2. Angiogenesis: The shockwaves encourage the formation of new blood vessels (angiogenesis) by stimulating endothelial cells and promoting the expression of vascular endothelial growth factor (VEGF). This improved blood flow is crucial for restoring erectile function. 3. Tissue Regeneration: LI-ESWT has been shown to enhance the recruitment and proliferation of stem cells to the treatment area, improving the regenerative capacity of the tissue. It also promotes nerve regeneration through the activation of pathways that support cell survival and growth. Mechanisms of Stem Cell Therapy: 1. Regenerative Potential: Stem cells possess the ability to self-renew and differentiate into various cell types, including smooth muscle and endothelial cells. This is critical for repairing damaged erectile tissue. 2. Secretion of Growth Factors: Stem cells secrete a variety of growth factors, cytokines, and chemokines that facilitate tissue healing, reduce inflammation, and promote angiogenesis. 3. Paracrine Effects: Stem cells exert their effects not only through direct differentiation but also through paracrine signaling, where they release soluble factors that influence neighboring cells, enhancing their survival and function. Combined Mechanisms: When used together, LI-ESWT and stem cell therapy create a synergistic effect. LI-ESWT enhances the mobilization and effectiveness of stem cells, improving their ability to reach and repair the damaged erectile tissue. The mechanical stimulation from LI-ESWT can also help to optimize the environment for stem cell function, thereby amplifying the overall therapeutic effect on erectile function. The review also discusses the mechanisms through which LI-ESWT promotes tissue regeneration and the recruitment of stem cells to the affected areas. While the combination therapy shows promise, the article points out existing knowledge gaps and the need for further research to understand the long-term effects and optimize treatment protocols. Additionally, it mentions the regulatory challenges faced by such therapies, as they have not yet received FDA approval for ED treatment, though they are recognized by the European Association of Urology (EAU). Jens Rassweiler

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