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Tag: ED

Adult Derived Stem Cells with Low-Intensity Shock Wave for the Treatment of Male Erectile Dysfunction

Posted on by admin

Treatment of Male Erectile Dysfunction

Regenerative medicine is a relatively young field in the treatment of various conditions. Several novel applications of various types of stem cells have been tried and applied in various aspects of urology. Some published articles provide promising early results.
 
There are two main sources of stem cells. These are embryonic stem cells (ESCs) and adult-derived stem cells (ADSC). The latter has many sources including bone marrow stem cells (BMSCs), skeletal-muscle-derived stem cells (SkMSCs), adipose-tissue-derived stem cells (ADSCs), and arguably, amniotic-fluid-derived stem cells (AFSCs).

Stem cell use in urology:

 
BMSCs, SkMSCs, and AFSCs have been used for bladder augmentation and detrusor regeneration in animals. SkMSCs are the only stem cells to have been successfully tested in humans, for the treatment of stress urinary incontinence. ESCs, BMSCs and SkMSCs have been shown to improve erectile function in animal models. Both ESCs and BMSCs can be differentiated into sperm and, remarkably, the ESC-derived sperms have generated offspring in mice.

Adipose-derived stem cells:


ADSC research is a relatively young field, and these cells are largely unstudied in urology. However, as a result of their high differentiation potential and ease of isolation, ADSCs represent an exciting resource for tissue engineering and regenerative medicine within and beyond urology.

ADSC’s need a target tissue to reach and excerpt their regenerative action. Signals are needed from the affected tissue to attract them.

Low-Intensity Shock Wave Therapy (Li-ESWT)

This relatively new modality of treatment is gaining acceptance with encouraging intermediate-term results, as proven with their approval as part of the urology guidelines.

Shock waves appear to induce micro trauma to the tether tissue hence, stimulate vascular flow and erectile function and one possible mechanism of action are through an endogenous stem cell-mediated regenerative effect. This micro trauma not only stimulates the local regenerative process, but the resultant signals act as a lighthouse for the ADSC’s to reach and synergistically enhance the local regenerative and repair process in the penile corpora.

Evidence:

Elliot Lander and Mark Berman reported a case series whereby 52 patients with Erectile Dysfunction received a concurrent combination of Li-ESWTand intracavernosal injection of autologous SVF (rich in MSCs and HSCs) from human lipoaspirate.

Initially SVF was harvested via liposuction and sent for preparation. Patients received Li-ESWT while awaiting the SVF preparation process. Then a tourniquet was applied to the base of the penis and 10 cc of SVF was injected into one side of the corpora cavernosa. The tourniquet was removed after 20 min.

Overall, 37 out of 52 patients (71%) reported an improvement in erectile function after combined SVF and Li-ESWT. None of the other fifteen patients reported worsening of their erectile function after treatment.

Future studies are needed in the form of placebo randomized trials to better establish the effects of stem cells combined with shock waves on Erectile Dysfunction.

Li-ESWT with Regenerative Medicine in ED

Posted on by Dr. Ali Thwaini

English


Erectile dysfunction (ED) is a very common health problem that affects a large proportion of men. The word “40 over 40” stands true. Various causes leading to various treatments for ED have been highlighted and adopted respectively. Most, if not all, are situational and not permanent ( apart from modifying lifestyle and care about Men’s health). 

Regenerative therapies for ED


Therefore, additional treatments are being investigated, including regenerative therapies. Regenerative therapies aim to restore function via replacement or regeneration of human cells, tissues, or organs. Regenerative therapies for the treatment of ED include low-intensity extracorporeal shockwave therapy (Li-ESWT).

Benefits of Li-ESWT


Li-ESWT began to be explored as an alternative means of treating ED,33 with the first randomized controlled trial (RCT) published in 2012. The benefits of Li-ESWT stems from its ability to induce microtrauma. A shockwave is a type of longitudinal acoustic wave that is composed of three sequential parts: a short pulse, a rapid increase to max positive acoustic pressure (the “shock”), and a prolonged period of negative pressure.

Stem Cell Therapies (SCT)


On the other hand, stem cell therapies (SCT) seek to harness the regenerative potential of stem cells for the repair of injured or damaged tissues. The utilization of adult stem cells has allowed for easier access to stem cells, leading to a higher likelihood of utility in regenerative medicine.


Since the causes of ED are numerous and include damage to the neurovascular bundle or neuropraxia during radical prostatectomy nerve damage, endothelial dysfunction, and oxidative stress in the setting of diabetes mellitus, SCT has gained a lot of interest in this field.


As opposed to PRP, several studies have evaluated the efficacy of SCT for the treatment of ED in humans, with promising results.


The combination of Li-ESWT and SCT in ED is an emerging concept. For stem cells to reach the affected tissues, and to accept their actions via paracellular and intercellular signals, they have to be “led” to the affected tissues. One method is to induce an acute micro-trauma to the targeted tissues allowing them to release their attractive signals for the relating cells, of more importantly here, the stem cells, to accumulate in that particular area and exceed their restorative tasks. Animal studies have already proven this concept. Human trials are awaited. Food for thought..

Reference : journals.sagepub


Arabic

Li-ESWT مع الطب التجديدي في الضعف الجنسي

ضعف الانتصاب (ED) هو مشكلة صحية شائعة جدًا تؤثر على نسبة كبيرة من الرجال. كلمة “40 فوق 40” صحيحة. تم تسليط الضوء على الأسباب المختلفة التي أدت إلى علاجات مختلفة للضعف الجنسي واعتمادها على الاسباب. معظمها ، إن لم يكن كلها ، ظرفية وليست دائمة (بصرف النظر عن تعديل نمط الحياة والاهتمام بصحة الرجل).

لذلك ، يتم التحقيق في علاجات إضافية ومستديمة ، بما في ذلك العلاجات التجديدية. تهدف العلاجات التجديدية إلى استعادة الوظيفة عن طريق استبدال أو تجديد الخلايا أو الأنسجة أو الأعضاء البشرية. تشمل العلاجات التجديدية لعلاج الضعف الجنسي علاجًا منخفض الكثافة بالموجات الصدمية خارج الجسم (Li-ESWT).

بدأ استكشاف Li-ESWT كوسيلة بديلة لعلاج الضعف الجنسي ، مع أول تجربة ذات ادله (RCT) نُشرت في عام 2012. تنبع فوائد Li-ESWT من قدرته على إحداث الصدمات الدقيقة. موجة الصدمة هي نوع من الموجات الصوتية الطولية التي تتكون من ثلاثة أجزاء متتالية: نبضة قصيرة ، وزيادة سريعة إلى أقصى ضغط صوتي إيجابي (“الصدمة”) ، وفترة طويلة من الضغط السلبي.

من ناحية أخرى ، تسعى علاجات الخلايا الجذعية (SCT) إلى تسخير الإمكانات المتجددة للخلايا الجذعية لإصلاح الأنسجة المصابة أو التالفة. توجيه استخدام الخلايا الجذعية البالغة بالوصول السهل إلى الخلايا الجذعية ، يؤدي إلى زيادة احتمالية الاستفادة منها في الطب التجديدي.

نظرًا لأن أسباب الضعف الجنسي عديدة وتشمل تلف الحزمة الوعائية العصبية أو الأعصاب أثناء تلف الأعصاب الجذري للبروستاتا ، والخلل البطاني ، والإجهاد التأكسدي في حالة مرض السكري ، اكتسبت SCT الكثير من الاهتمام في هذا المجال.

على عكس PRP ، قيمت العديد من الدراسات لفعالية SCT في علاج الضعف الجنسي لدى البشر ، مع نتائج واعدة.

يعتبر الجمع بين Li-ESWT و SCT في ED مفهومًا ناشئًا. لكي تصل الخلايا الجذعية إلى الأنسجة المصابة ، وباستثناء أفعالها عبر الإشارات بين الخلايا والداخلية ، يجب “توجيهها” إلى الأنسجة المصابة. تتمثل إحدى الطرق في إحداث صدمة صغيرة حادة للأنسجة المستهدفة مما يسمح لها بإطلاق إشاراتها الجذابة للخلايا ذات الصلة ، والأهم من ذلك ، الخلايا الجذعية ، لتتراكم في تلك المنطقة بالذات وتتجاوز مهامها التصالحية. لقد أثبتت الدراسات التي أجريت على الحيوانات بالفعل هذا المفهوم.

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