STEM CELL THERAPY FOR ERECTILE DYSFUNCTION

Medical doctors once believed that Erectile dysfunction (ED) was merely a psychological issue.  But today more and more evidence indicates that most cases of ED are the result of either systemic diseases such as diabetes, atherosclerosis and aging or physical issues such as loss of blood flow, lack of nitric oxide or nerve injury.

Amongst the list of diseases that are associated with physical causes include aging, Peyronie’s disease and cavernous nerve injury, which is common after radical prostatectomy for prostate cancer [1].

These all lead to significant damage to the neurovascular bundles and autonomic innervation of the penis, resulting in scarring of the corpus cavernosa, which we all believed was an irreversible condition, until now [2].

Autologous stem cells, or stem cells derived from your own body are becoming the new hope for eradicating ED from any cause and the evidence is remarkable [3].

Stem Cell Therapy for Erectile Dysfunction

The recognition that nitric oxide (NO) causes erections led to the development of phosphodiesterase type 5 (PDE5) inhibitors (PDE5-i) such as sildenafil (Viagra®, Revatio®), vardenafil (Levitra®) and tadalafil (Adcirca® and Cialis®) [4]. But if the nitric oxide pathways are disrupted, then these drugs just won’t work.  Plus the underlying cause of the ED is never really dealt with.

Diseases in which the availability of NO is reduced include severe diabetes with neuropathy and endothelial dysfunction, metabolic syndrome, and down-regulation or deactivation of NO synthase (NOS) expression, which can occur in denervation of the erectile tissue after radical prostatectomy, atherosclerosis, advanced age, and hypogonadism. Overall efficacy rates of PDE5-i are currently 60–70% with on-demand treatment regimens [5, 6].

Men who persistently fail to respond to PDE5-i might require intracavernous injections of vasoactive substances, e.g. prostaglandin E1 and papaverine (bimix, trimic, etc), to regain erectile function, and when these treatments fail patients must resort to the surgical implantation of inflatable penile prostheses. It is clear that current treatments for ED are aimed at providing symptom relief and do not represent a curative approach [7].

Despite all this, patients still demand that the most important treatment outcome and measure of success is the ability of a therapy cure them of their disease and ED [8]. Thus an ideal future therapy for ED would focus on identifying a disease-specific therapy with curative intent.  And autologous stem cells are proving to be just that, “the cure” where the future is now.

Various groups worldwide are currently involved in investigating how cell-based therapy, specifically autologous stem cells, might be the “cure” in reversing the different pathophysiological processes in the establishment of ED to halt or reverse the development of this prevalent sexual dysfunction.

What exactly are stem cells and how do they repair?

Stem Cells are by definition capable of self-renewal (which means they can make exact copies of themselves, indefinitely) and can differentiate into any cell that needs to be repaired or replaced [9]. They can functionally and structurally regenerate damaged tissues, depending on the stimuli or signals they receive. When a stem cell divides, both daughter cells have the potential either to remain as stem cells or to become a more specialized type of cell, e.g., muscle, bone, cartilage, blood vessels, nerves or brain.  So ultimately, these stem cells can rebuild lost blood vessels, reverse scarring, regenerate damaged nerves, bring back healthy nitric oxide receptors, etc. for the purpose of bringing the vital structures of the penis back to normal to achieve youthful erections.

The Controversy

As opposed to harvesting embryonic stem cells that requires the destruction of human embryos, which has also raised significant ethical and political restrictions, autologous stem cells derived from one’s own body do not have any ethical or political implications and carry with it “a perfect match” because they belong to the patient.  Therefore, there are no issues with host-versus-graft and there is no need for any medications to suppress the immune system.  In addition, the cells are easily harvested and plentiful, especially if gotten from the fat.  The best yet is that the patient is awake during the entire procedure with no pain and minimal downtime.

Stem Cell Types

In erectile dysfunction research, three types of adult stem cells are commonly used, including adipose tissue-derived stem cells (ADSCs), bone marrow-derived stem cells (BMSCs), and muscle-derived stem cells (MDSC). All of these stem cells have been defined as mesenchymal stem cells, indicating that they can differentiate into various cell types within the mesodermal germ line, such as muscle, nerve, fat, cartilage and bone cells [9, 10].

Although bone marrow derived stem cells have been the traditional source of stem cells used in bone marrow transplantation, adipose or fat derived stem cells are a distinct population of mesenchymal derived stem cells residing in the perivascular niche of adipose tissue known as the stromal vascular fraction (SVF) [11, 12]. The possibility of harvesting large amounts of tissue (>100 grams) allows for direct re-injection of cells (the stromal vascular fraction, SVF) in the same surgical procedure during which they were harvested [13].  Approximately 50 times more mesenchymal stem cells can be obtained from adipose tissue than from bone marrow.  So there is no need to “incubate” and “culture” these cells, and no need to wait for the cells to grow in a petri dish to be inserted at a later date.  They are re-injected into the area of injury on the same day of the procedure.

In addition to the healing powers of these adipose derived stem cells within the SVF, the SVF has stronger capacities of cell renewal due to their abundance of growth factors and cytokines [14, 15]. In this sense it is possible and increasingly believed that stem cells derived from SVF have their beneficial effects on damaged or diseased tissues by releasing various molecular mediators, which in turn stimulate the host tissue to initiate a regenerative or healing response to disease or injury. This hypothesis is supported in many different preclinical studies [16].

The many uses of autologous adult stem cells include:

  • Cavernous nerve injury – studies report a significant improvement in erectile function through the regeneration of nerve [17].
  • Diabetes, aging and metabolic syndrome – studies report that after a single intra-cavernous injection into the penis with adult stem cells, blood glucose levels decreased, anti-diabetic medication dosages were reduced, and glycosylated hemoglobin levels improved for up to 4 months [18].
  • Aging – studies show improvement of age-related erectile dysfunction with stem cells injected into the cavernous of the penis by improving vascularity, smooth muscle and nitric oxide production [19, 20, 21]
  • Peyronie’s Disease – Castiglione and colleagues were the first to report the potential benefit of adipose derived stem cells in Peyronie’s disease [22].  Ferretti et al. showed that injection with stem cells into the scar of Peyronie’s disease resulted in decreased penile curvature at 2 months after the injection [23, 24]. These two studies hint at a novel application of stem therapy within the field of erectile dysfunction.

Are there any issues with cancer?

Although many fear that autologous stem cells should not be used in patients with cancer, a study reported in March of 2014 showed how autologous stem cells actually inhibited prostate cancer cell proliferation inducing apoptosis (programmed cell death) thus minimizing the worry and concern in patients with cancer [25].

Conclusions

The studies on the use of autologous stem cells for erectile dysfunction provide great hope in the race for a cure for men with erectile dysfunction.

At the DaSilva Institute, all of our stem cell treatments are performed according to FDA standards and have been reviewed by the Institutional Review Board.  Above all, your well-being and safety are always foremost in our minds.

Your precious cells never leave our office. Unlike some doctors, who outsource processing to foreign countries, all work is done in our Sarasota clinic right in our own “State of the Art” Stem Cell Laboratory.  If you were thinking of flying somewhere for stem cell therapy or platelet rich plasma procedure, there’s no need to leave the country!  Florida is the Sunshine State, perfect for a medical vacation.

Get on your way to the best health you’ve enjoyed in years!