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Shin D. et al., 2021: Extracorporeal shock wave therapy combined with engineered mesenchymal stem cells expressing stromal cell-derived factor-1 can improve erectile dysfunction in streptozotocin-induced diabetic rats.

Shin D, Jeon SH, Tian WJ, Kwon EB, Kim GE, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW.
Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea.

Abstract

Background: For erectile dysfunction (ED) in diabetes mellitus (DM) patients who have poor response to drugs, extracorporeal shock wave therapy (ESWT) and engineered mesenchymal stem cell (MSC) therapy have been studied as alternative treatment options. The objective of this study is to investigate whether ESWT in combination with stromal cell-derived factor-1 expressing engineered mesenchymal stem cell (SDF-1 eMSC) therapy can have synergistic effects on ED in streptozotocin-induced diabetic rats.

Methods: Fifty 8-week-old male Sprague-Dawley rats were randomly divided into five groups (N=10 per group): (I) Normal group, (II) DM ED, (III) DM ED + ESWT group, (IV) DM ED + SDF-1 eMSC group, and (V) DM ED + ESWT + SDF-1 eMSC group. Each groups were treated with bilateral injections of SDF-1 eMSC or ESWT following the experiment protocol for eight weeks.

Results: The ratio of ICP/MAP was distinctly higher in the DM ED + ESWT + SDF-1 eMSC group than that in the DM ED group. Concentration of α-smooth muscle actin (α-SMA) was elevated the highest in the DM ED + ESWT + SDF-1 eMSC group. Additionally, ESWT increased the intensity of SDF-1 expression in the corpus cavernosum. ESWT + SDF-1 eMSC treatment also induced neuronal nitric oxide synthase (nNOS) and NO/cGMP expression in the corpus cavernosum. Furthermore, numbers of penile progenitor cells were increased in DM ED rats.

Conclusions: Combined treatment of ESWT with SDF-1 eMSC treatment is more effective than by a single therapy. It could be used as a potential and effective synergistic treatment for DM ED.

Keywords: Extracorporeal shockwave therapy (ESWT); erectile dysfunction (ED); mesenchymal stem cells (MSCs); penis; streptozotocin diabetes.
Transl Androl Urol. 2021 Jun;10(6):2362-2372. doi: 10.21037/tau-21-79. PMID: 34295723

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Comments 1

Peter Alken on Tuesday, 15 February 2022 09:30

The paper is published in the open access journal Sexual Medicine Reviews. The full price publishing charge for the journal is 3220 US$ and only 665US$ for members of the International Society of Sexual Medicine.
I do not understand enough of this type of basic research to judge the quality of the paper or the horizon studies like this open.
Two minor details attracted my attention: The animal model and an outlook. 12 weeks after induction of the diabetes by streptomycin injection, erectile function was evaluated by a kind of simple physiological test. “When seminal stain was not found in a week after putting adult female rat with a streptozotocin (STZ)-induced DM rat together, this experimental rat was included for the next process. The rat was excluded when seminal stain appeared.” At the end of the experiments, erectile function was evaluated by measuring the intracorporeal penile blood pressure after cavernous nerve stimulation. This is of course more scientific than looking at seminal stains again. However, I wonder what effect the streptozotocin (STZ) had on other organ systems and if this was not a study on very sick rats. The author did not mention anything about the conditions of rats. STZ may produce pulmonary and gastrointestinal leasions, testicular damage and Alzheimer type changes (1). What human condition would a sick rat with low testosterone and Alzheimer changes resemble to and would it help to restore sexual function?
One of the conclusions was “Considering that EWST + SDF-1 eMSC therapy is a localized treatment, we believe that this therapy can help drugs penetrate into the corpus cavernosum and enhance absorption of drugs. Clinical trials are needed to determine whether additional oral medications or IV injections could enhance treatment efficacy in the future.” I found no clue substantiating this expectation in the paper.

Peter Alken

1 Goyal SN, Reddy NM, Patil KR, Nakhate KT, Ojha S, Patil CR, Agrawal YO. Challenges and issues with streptozotocin-induced diabetes - A clinically relevant animal model to understand the diabetes pathogenesis and evaluate therapeutics. Chem Biol Interact. 2016 Jan 25;244:49-63. doi: 10.1016/j.cbi.2015.11.032. Epub 2015 Dec 2. PMID: 26656244.

The paper is published in the open access journal Sexual Medicine Reviews. The full price publishing charge for the journal is 3220 US$ and only 665US$ for members of the International Society of Sexual Medicine. I do not understand enough of this type of basic research to judge the quality of the paper or the horizon studies like this open. Two minor details attracted my attention: The animal model and an outlook. 12 weeks after induction of the diabetes by streptomycin injection, erectile function was evaluated by a kind of simple physiological test. “When seminal stain was not found in a week after putting adult female rat with a streptozotocin (STZ)-induced DM rat together, this experimental rat was included for the next process. The rat was excluded when seminal stain appeared.” At the end of the experiments, erectile function was evaluated by measuring the intracorporeal penile blood pressure after cavernous nerve stimulation. This is of course more scientific than looking at seminal stains again. However, I wonder what effect the streptozotocin (STZ) had on other organ systems and if this was not a study on very sick rats. The author did not mention anything about the conditions of rats. STZ may produce pulmonary and gastrointestinal leasions, testicular damage and Alzheimer type changes (1). What human condition would a sick rat with low testosterone and Alzheimer changes resemble to and would it help to restore sexual function? One of the conclusions was “Considering that EWST + SDF-1 eMSC therapy is a localized treatment, we believe that this therapy can help drugs penetrate into the corpus cavernosum and enhance absorption of drugs. Clinical trials are needed to determine whether additional oral medications or IV injections could enhance treatment efficacy in the future.” I found no clue substantiating this expectation in the paper. Peter Alken 1 Goyal SN, Reddy NM, Patil KR, Nakhate KT, Ojha S, Patil CR, Agrawal YO. Challenges and issues with streptozotocin-induced diabetes - A clinically relevant animal model to understand the diabetes pathogenesis and evaluate therapeutics. Chem Biol Interact. 2016 Jan 25;244:49-63. doi: 10.1016/j.cbi.2015.11.032. Epub 2015 Dec 2. PMID: 26656244.
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