Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions

Role of interaction mode of phenanthrene derivatives as selective PDE5 inhibitors using molecular dynamics simulations and quantum chemical calculations

Phosphodiesterase type 5 (PDE5) inhibitors play a crucial role in blocking PDE5 to improve erectile dysfunction (ED). However, most PDE5 drugs revealed side effects including the loss of vision due to the PDE6 inhibition. Phenanthrene derivatives isolated from E. macrobulbon were previously reported as PDE5 inhibitors. Two phenanthrene derivatives (cpds 1-2) revealed better inhibition to PDE5 than PDE6 and cpd 1 is more selective to PDE5 than cpd 2. To elucidate why the phenanthrene derivatives could inhibit PDE5 and PDE6, their binding modes were investigated using molecular dynamics simulations and quantum chemical calculations, as compared to the PDE5 drugs. From the results, all four drugs and phenanthrene derivatives revealed similar π-π interactions to Phe820 in PDE5. Additional H-bond interaction to Gln817 in PDE5 resulted in better PDE5 inhibition of vardenafil and tadalafil. Moreover, cpds 1-2 were able to form the H-bond interaction with Asp764 in PDE5. In the case of the PDE6, the loss of π-π interaction to Phe776 and H-bond interaction to Gln773 indicated the important points for losing the PDE6 inhibition. In conclusion, to develop the new potent PDE5 inhibitors, not only the important interaction with PDE5 but also the interaction with PDE6 should be considered. In phenanthrene derivatives, the middle ring was significant to form π-π interactions to Phe820 in PDE5 and hydroxyl substituent was also the key part to form the H-bond interaction with Asp764 in PDE5. Principal component analysis (PCA) and free energy landscape (FEL) analysis indicated the stability of the system. The bioavailability, drug-likeness, and pharmacokinetics of phenanthrene derivatives were also predicted. These derivatives revealed good drug-likeness and GI absorption. The obtained results showed that phenanthrene derivatives could be interesting for the development of PDE5 inhibitors in the future.

A New and Safe Delivery of Sildenafil Citrate Co-Evaporate Loaded Emulgels for the Cure of Certain Male Sexual Dysfunctions

The present work focuses on the production of sildenafil co-evaporates loaded emulgels as topical dosage forms for the treatment of premature ejaculation and erectile dysfunction. Topical administration of sildenafil citrate (SILD) co-evaporates is expected to improve the bioavailability profile of the drug and to avoid the severe side effects accompanying the traditional SILD dosage forms, especially for prohibited cardiovascular cases. Firstly, the solubility of SILD was improved via solid dispersion via co-evaporation technique using PEG-5KDa and PVP-K90 as hydrophilic carriers. The modified co-evaporates were characterized by DSC, XRD, and solubility studies. Different emulgels, loaded with SILD co-evaporates, were formulated and characterized by different analyses including the viscosity, stability, spreadability, and in vitro release studies. Finally, the clinical activity of the chosen formula was accomplished via the application of the emulgels on volunteers suffering from erectile dysfunction. The results showed that the prepared SILD/PVP K90 of 1:2 w/w ratio exhibited the highest solubility and dissolution rate. All formulated emulgels exhibited good physicochemical properties. Especially, the emulgel formula composed of 2%w/v HPMC, loaded with SILD /PVP- K90, revealed the highest release rate. The release mechanism of SILD from emulgels fits with the Korsmeyer Peppas mechanism. The results of in vivo studies indicated a significant improvement of both IVLT and IIEF-5 parameters in mild to moderate ED, accompanied by PE. The modified SILD emulgel is an alternative promising and safe transdermal drug delivery system for the management and treatment of mild to moderate ED with PE.

Association of total testosterone levels with cardiometabolic diseases in men with erectile dysfunction

Background

Both serum testosterone (T) levels and erectile dysfunction (ED) are associated with systemic diseases in men and ED is the most common presenting symptom of hypogonadism.

Aim

To evaluate the association of serum total testosterone (TT) levels with cardiometabolic diseases in men with ED.

Methods

Serum endogenous TT levels were determined to evaluate their associations with cardiometabolic diseases in men with ED in outpatient clinics. Participants were divided into hypogonadal with TT < 350 ng/dL (12.1 nmol/L) and eugonadal groups, as well as into four equal quartiles based on TT levels. The Framingham risk score was used to estimate individual 10-year coronary heart disease (CHD) risk.

Main Outcome Measures

Cardiometabolic factors included obesity, diabetes mellitus (DM), hypertension (HT), dyslipidemia, and the Framingham risk score.

Results

From 2010 to 2021, a total of 4467 subjects with ED were consecutively recruited for this study, and 3909 subjects' (87.5%) data with a mean age of 53.0 ± 12.9 (20.0-88.0) years had data eligible for analysis. Testosterone levels declined with age and a higher body mass index (BMI) was associated with lower T levels across all age groups (P < .001). Compared to the eugonadal group, the hypogonadal group was older and had a higher BMI and more cardiometabolic diseases (all P < .01). In multivariate analysis, odds ratio (OR) for hypogonadism was highest in men with obesity (2.51), followed by age group of ≥70 years (2.32), DM (1.59), HT (1.41), and dyslipidemia (1.26). Compared with the lowest TT quartile, higher quartiles of TT had significantly lower risk for cardiometabolic diseases (all P < .001). Among men over 50 yrs, hypogonadal men had a higher 10-year CHD risk than eugonadal men as predicted by the Framingham risk score (P < .001).

Clinical implications

Our results highlight the value of determining TT levels in men with ED because of their association with cardiometabolic diseases and the potential benefits of T therapy for improving men's health.

Strengths and Limitations

Strengths of this study include a relatively large sample and detailed medical history collection. Limitations included a small portion of subjects with repeat TT tests, and the lack of data on free T and bioavailable T levels, and single-site recruitment.

Conclusions

TT levels are independently associated with cardiometabolic diseases including obesity, DM, HT, and dyslipidemia, and indicate a higher risk for CHD in men with ED. Measuring TT levels in men with ED presents an opportunity to improve overall health and reduce CV risk.

Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium

INTRODUCTION

Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023.

OBJECTIVES

Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area.

METHODS

An expert panel reviewed existing research and clinical practice guidelines.

RESULTS

Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications.

CONCLUSION

Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.

Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction

We sought to assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction. Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction. Covariates were assessed using a multivariable model to determine association of prior COVID-19 infection with newly diagnosed erectile dysfunction. 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 601 (1.42%) developed new onset erectile dysfunction within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and malignancy, prior COVID-19 infection was associated with increased risk of new onset erectile dysfunction (HR 1.27; 95% CI 1.1-1.5; P = 0.002). Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed erectile dysfunction is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset erectile dysfunction when compared to those without prior infection.

Mesenchymal stem cell secretome: A promising therapeutic strategy for erectile dysfunction?

Objective

The secretome, comprising bioactive chemicals released by mesenchymal stem cells (MSCs), holds therapeutic promise in regenerative medicine. This review aimed to explore the therapeutic potential of the MSC secretome in regenerative urology, particularly for treating erectile dysfunction (ED), and to provide an overview of preclinical and clinical research on MSCs in ED treatment and subsequently to highlight the rationales, mechanisms, preclinical investigations, and therapeutic potential of the MSC secretome in this context.

Methods

The review incorporated an analysis of preclinical and clinical research involving MSCs in the treatment of ED. Subsequently, it delved into the existing knowledge regarding the MSC secretome, exploring its therapeutic potential. The methods included a comprehensive examination of relevant literature to discern the processes underlying the therapeutic efficacy of the MSC secretome.

Results

Preclinical research indicated the effectiveness of the MSC secretome in treating various models of ED. However, the precise mechanisms of its therapeutic efficacy remain unknown. The review provided insights into the anti-inflammatory, pro-angiogenic, and trophic properties of the MSC secretome. It also discussed potential advantages, such as avoiding issues related to cellular therapy, including immunogenicity, neoplastic transformation, and cost.

Conclusion

This review underscores the significant therapeutic potential of the MSC secretome in regenerative urology, particularly for ED treatment. While preclinical studies demonstrate promising outcomes, further research is essential to elucidate the specific mechanisms underlying the therapeutic efficacy before clinical application. The review concludes by discussing future perspectives and highlighting the challenges associated with the clinical translation of the MSC secretome in regenerative urology.

Etiology of Male Infertility: an Update

Spermatogenesis is a complex process of germ cell division and differentiation that involves extensive cross-talk between the developing germ cells and the somatic testicular cells. Defective endocrine signaling and/or intrinsic defects within the testes can adversely affect spermatogenic progression, leading to subfertility/infertility. In recent years, male infertility has been recognized as a global public health concern, and research over the last few decades has elucidated the complex etiology of male infertility. Congenital reproductive abnormalities, genetic mutations, and endocrine/metabolic dysfunction have been demonstrated to be involved in infertility/subfertility in males. Furthermore, acquired factors like exposure to environmental toxicants and lifestyle-related disorders such as illicit use of psychoactive drugs have been shown to adversely affect spermatogenesis. Despite the large body of available scientific literature on the etiology of male infertility, a substantial proportion of infertility cases are idiopathic in nature, with no known cause. The inability to treat such idiopathic cases stems from poor knowledge about the complex regulation of spermatogenesis. Emerging scientific evidence indicates that defective functioning of testicular Sertoli cells (Sc) may be an underlying cause of infertility/subfertility in males. Sc plays an indispensable role in regulating spermatogenesis, and impaired functional maturation of Sc has been shown to affect fertility in animal models as well as humans, suggesting abnormal Sc as a potential underlying cause of reproductive insufficiency/failure in such cases of unexplained infertility. This review summarizes the major causes of infertility/subfertility in males, with an emphasis on infertility due to dysregulated Sc function.

Prospective Patient Preferences for Humor in Urologists Treating Erectile Dysfunction: A Survey Study

INTRODUCTION

Men seeking treatment for sexual dysfunction can experience embarrassment as a result of stigma. This research manuscript presents the findings of a survey conducted to investigate the influence of humor on prospective patients' preferences when selecting a specialist to address erectile dysfunction (ED).

METHODS

The respondents were presented with five pairs of mock urology business cards: one professional and one humorous. A questionnaire was designed and distributed via an online survey platform. Descriptive statistics and Fisher's exact test were performed using the Statistical Package for Social Sciences (SPSS) software version 29 (IBM SPSS Statistics, Armonk, NY) to evaluate age and race associations with card preference.

RESULTS

Among the 997 participants, an average of 66.1% (a median of 71.2%) preferred professional cards. Humorous card selection rates ranged from 5.2% to 38.4% compared to 54.0% to 78.1% for professional cards. A statistically significant relationship between age and professional card choice existed in all except the fifth set of cards (p = 0.001, 0.001, 0.001, 0.001, and 0.054). The relationship between race or ethnicity and business card preference was not reported due to an imbalance in demographics, with most participants identifying as Caucasian.

DISCUSSION

A humor-centric approach may not resonate with all individuals seeking treatment for sensitive conditions such as ED. Limitations include the subjectivity of humor, the use of an online survey platform, and the hypothetical nature of this study. Real patients experiencing ED may face stigma and respond to humor differently.

CONCLUSION

This study provides insights into patient preference for professionalism over humor from their urologist but leaves room for the exploration of humor in medical contexts. Future studies could examine the impacts of humor on patient choices in real-world healthcare settings.

Erectile Dysfunction: Current Best Practices

Erectile dysfunction is a health condition that many men face in the United States. Nurses are primed to help men break the stigma; assess, manage, and treat the underlying factors; and educate men and their partner(s) regarding their health condition. Together they can work toward ensuring the patient maintains their sexual health and quality of life throughout their lifespan.

Proniosomal Gel-Loaded Phosphodiesterase Inhibitors (Sildenafil, Vardenafil, and Tadalafil): Prospects for Topical Penile Therapy of Tadalafil for Treatment of Erectile Dysfunction

Oral phosphodiesterase inhibitors have emerged as a game changer for the treatment of erectile dysfunction (ED) since attaining FDA approval for its first member, sildenafil, in 1998. Topical penile therapy could be a viable replacement for oral medication that would transform the treatment of ED for many decades to come. This innovative idea could offer a safer topical alternative with less vision and cardiovascular side effects than the oral route. This work aims at developing proniosomal gels for three selected members (sildenafil, vardenafil, and tadalafil) and investigating the proniosomal gels on a rodent model. Niosomes derived from the parent proniosomal gels were characterized for entrapment efficiency (EE%), size, polydispersity index (PDI), zeta potential, and morphology. Proniosomal gels were evaluated for skin permeation, in vivo mating behaviors, and biochemical assays of nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) post penile topical administrations. The optimized proniosomes loaded with tadalafil (F1-T) were compared with oral tablets (Cialis®). Proniosomal gels demonstrated significant enhancement of skin penetration by up to 5.5-fold, compared to control topical suspension. Tadalafil-loaded proniosomes showed superior skin permeability over sildenafil- and vardenafil-loaded proniosomes. In addition, significant improvement was noticed regarding intromission number, intromission ratio, NO, and cGMP for the proniosomal gel F1-T, compared to the untreated control. No statistically significant (p > 0.05) differences in sexual performance or biochemical parameters (NO and cGMP levels) were recorded among orally and topically (tadalafil proniosomal gel) administered groups. These findings support tadalafil topical penile therapy as a promising alternative to the oral route.

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Background

Health services are critically important for older adults, particularly during the Coronavirus disease-19 (COVID-19) pandemic. However, COVID-19 risks, worse financial situation, and lowered income may seriously impact health services by feasibility and accessibility. Therefore, the aim of the present study was empirically to explore how health-seeking behaviors are influenced by new health conditions through COVID-19 risks, worse financial situation, and lowered income.

Methods

Data were from ELSA COVID-19 waves 1 and 2 which included a sample of 6952 and 6710 older adults in the United Kingdom, respectively. The frequency distribution analyses were conducted by Chi-square analysis by gender groups. Zero-inflated Poisson regressions were used to examine how worse financial situation and lowered income were associated with COVID-19 risks and new health conditions. Logistic regressions were employed to examine the associations of COVID-19 risks, worse financial situation, and lowered income with treatment cancellation and accessible care. Cross-sectional mediation models, cross-sectional moderation models, longitudinal mediation models, and longitudinal moderation models were conducted based on Hayes model 6, Hayes model 29, Montoya model 1, and Montoya model 2, respectively.

Results

Most of the sample was >65 years old, females, located in urban place, and involved in long-standing condition. Regression analysis showed that COVID-19 risks, worse financial situation, and lowered income were associated with treatment cancellation and accessible care. In the longitudinal mediations, effect coefficients of ‘X’ → (treatment cancellation in wave 1 (Tcn1)- treatment cancellation in wave 2 (Tcn2))(β = −.0451, p < .0001, low limit confidence interval (LLCI) = −.0618, upper limit confidence interval (ULCI) = −.0284), ‘X’ → (COVID-19 risks in wave 1 (Csk1)- COVID-19 risks in wave 2 (Csk2)) (β = .0592, p < .0001, LLCI = .0361, ULCI = .0824), and ‘X’ → (lowered income in wave 1 (CIn1)- lowered income in wave 2 (CIn2)) (β = −.0351, p = .0001, LLCI = -.0523, ULCI = -.0179) were significant. Additionally, effect coefficients of ‘X’ → (accessible care in wave 1 (Acr1)- accessible care in wave 2 (Acr2)) (β = .3687, p < .0001, LLCI = .3350, ULCI = .4025),'X’ → (Csk1- Csk2) (β = .0676, p = .0005, LLCI = .0294, ULCI = .1058), and ‘X’ → (worse financial situation in wave 1- worse financial situation in wave 2) (β = −.0369, p = .0102, LLCI = -.0650, ULCI = -.0087) were significant.

Conclusions

There were longitudinal mediating effects of COVID-19 risks, worse financial situation, and lowered income on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care. These findings suggest that worse financial situation, lowered income, and COVID-19 risks exerted an influence on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care among older adults. Findings suggest that longitudinal mediations may be important components of interventions aiming to meet service needs. Long-term health policy implications indicate the need for reducing COVID-19 risks, improving financial situation, and increasing income among the targeted population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02995-8.

Effect of liver cirrhosis on erectile function in rats: A study combining bioinformatics analysis and experimental research

To explore the mechanism through which liver cirrhosis (LC) causes erectile dysfunction (ED). Bioinformatic analysis was used to predict the potential signalling pathways in LC-induced ED, and N-nitrosodiethylamine was used to establish a rat model of LC. H&E staining, Western blotting and RT-qPCR were used to detect pathological tissue damage and changes in mRNA and protein expression levels. In addition, the expression levels of sex hormones such as estradiol (E2), prolactin (PRL) and testosterone (T) were measured. The hypoxia-inducible factor (HIF) pathway was an important pathway in our bioinformatics prediction. Pathological damages were detected in the liver and penile tissues of the model rats. Compared with the normal group's serum hormone levels, E2 and PRL were increased in LC rats, while T was decreased (p < 0.01). The mRNA and protein expression results from penis tissues showed that endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) were both downregulated, and HIF-1α was upregulated in the model group compared to the normal group (p < 0.01). These data suggest that LC hinders erectile function and causes histopathological changes in the penis by affecting the expression of HIF-1α, eNOS, iNOS, E2, PRL and T.