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Link Between Erectile Dysfunction And Obesity

By: Mary Ann Liebert, Inc./Genetic Engineering News
Source: Science Daily
web site: https://www.sciencedaily.com/releases/2009/08/090824182531.htm

Link Between Erectile Dysfunction And Obesity Explored In Obesity And Weight Management

Obese men are at increased risk for erectile dysfunction (ED), likely caused by atherosclerosis-related hypertension and cardiovascular disease, as well as hormonal changes associated with obesity, as described in a timely article published in Obesity and Weight Management.

As many as 30-40% of men over the age of 50 may experience ED, and both obesity and physical inactivity may increase their risk. The build-up of atherosclerotic plaque in th49e arteries of obese men can damage the arterial lining and contribute to elevated blood pressure. In addition to atherosclerosis, the hormonal changes that accompany obesity, including lower testosterone, increase the risk of ED. The modifiable risk factors for heart disease, such as excess weight, diabetes, and hypertension, are generally the same as those for ED. Studies have shown that weight loss and increased physical activity can improve ED.

Adam Gilden Tsai, MD, MSCE, from the University of Colorado Denver, and David Sarwer, PhD, from the University of Pennsylvania School of Medicine, describe a 48-year-old man with mild obesity (weight = 197 lbs, body mass index = 32.6 kg/m2 ) and hypertension who suffers from ED in the article "Obesity and Erectile Dysfunction." Even with the use of ED medication (tadalafil, Cialis, Eli Lilly), he was not able to achieve an erection adequate for intercourse. After dietary counseling, a 4.6% weight reduction, and medication to lower his blood pressure to within the normal range (112/77 mm Hg), the patient has been able to achieve adequate erections with the use of ED medication as needed.

The authors emphasize that "the complicated interplay of weight and other health conditions relate to common medical symptoms, such as ED. We are reminded that atherosclerosis can cause not only macrovascular disease such as heart attack and stroke, but also microvascular disease, of which ED is one example."

"If you are looking for another reason to lose weight, research now suggests that erectile dysfunction can improve with weight loss," says James O. Hill, PhD, Editor-in-Chief of Obesity and Weight Management, Professor of Pediatrics and Medicine and Director of the Center for Human Nutrition and of the Colorado Clinical Nutrition Research Unit at the University of Colorado Denver.

Erectile dysfunction drug 'effective' as heart failure treatment

By: University of Manchester
Source: Science Daily
web site: https://www.sciencedaily.com/releases/2019/05/190501081953.htm

A drug used to treat erectile dysfunction has been found by University of Manchester scientists to slow or even reverse the progression of heart failure in sheep.

The British Heart Foundation funded study is a breakthrough in the treatment for the disease in which five year survival rates are lower than most common cancers.

The study of Tadalafil -- which is in the same class as Viagra -- proves that the drug is biologically effective as a treatment for heart failure in sheep.

However, lead author Professor Andrew Trafford argues the effect is likely to also be shown in humans. The study is published in the journal Scientific Reports.

Heart failure is a devastating condition, occurring when the heart is too weak to pump enough blood to meet the body's needs.

It also causes a build-up of fluid that backs up into the lungs, resulting in breathlessness as well fluid retention, resulting in swelling of different parts of the body.

Most current treatments are ineffective.

"This discovery is an important advance in a devastating condition which causes misery for thousands of people across the UK and beyond," said Professor Trafford.

"We do have limited evidence from human trials and epidemiological studies that show Tadalafil can be effective in treating heart failure.

"This study provides further confirmation, adds mechanistic details and demonstrates that Tadalafil could now be a possible therapy for heart failure.

"It's entirely possible that some patients taking it for er`ectile dysfunction have also unwittingly enjoyed a protective effect on their heart."

Sheep were used by the team as the physiology their hearts is similar to human hearts.

When the animals had heart failure -- induced by pace makers -- which was sufficiently advanced to need treatment, the team administered the drug. Within a short period the progressive worsening of the heart failure was stopped and, importantly the drug reversed the effects of heart failure.

And the biological cause of breathlessness in heart failure- the inability of the heart to respond to adrenaline was almost completely reversed.48

The dose the sheep received were similar to the dose humans are given when being treated for erectile dysfunction.

Tadalafil blocks an enzyme called Phosphodiesterase 5 or PDE5S for short, which regulates how our tissue responds to hormones like adrenaline.

The research team found that in heart failure, the drug altered the signalling cascade -- a series of chemical reactions in the body -- to restore the hearts ability to respond to adrenaline.

And that increases the ability of the heart to force blood around the body when working harder.

Professor Trafford added: "This is a widely used and very safe drug with minimal side effects.

"However we would not advise the public to treat themselves with the drug and should always speaking to their doctor if they have any concerns or questions.

"Tadalafil is only suitable as a treatment for systolic heart failure -- when the heart is not able to pump properly -- and there may be interactions with other drugs patients are taking."

Professor Metin Avkiran, Associate Medical Director at the British Heart Foundation, said:

"Viagra-type drugs were initially developed as potential treatments for heart disease before they were found to have unexpected benefits in the treatment of erectile dysfunction. We seem to have gone full-circle, with findings from recent studies suggesting that they may be effective in the treatment of some forms of heart disease -- in this case, heart failure.

"We need safe and effective new treatments for heart failure, which is a cruel and debilitating condition that affects almost a million people in the UK. The evidence from this study -- that a Viagra-like drug could reverse heart failure -- should encourage further research in humans to determine if such drugs may help to save and improve lives."

Improved procedure for cancer-related erectile dysfunction

By: University of Melbourne
Source: Science Daily
web site: https://www.sciencedaily.com/releases/2019/04/190412094731.htm

Melbourne surgeons have modified a minimally invasive technique to help men regain erectile function lost after prostate cancer surgery.

The surgery had a 71 per cent success rate with two participants achieving their first erection in 12 years.

Published in European Urology, the study is the first to report this procedure, which can restore the ability to have satisfactory sexual intercourse and improve sexual quality of life in men with erectile dysfunction following a nerve-sparing or non-nerve-sparing radical prostatectomy.

Of the 8500 Australian men with prostate cancer who have a radical prostatectomy each year, at least 70 per cent experience erectile dysfunction. Many are unaware of the risk or suffer in silence.

Treatment usually involves injections or a prosthesis, which can have side effects. The improved technique, pioneered in Brazil, uses a nerve removed from the patient's leg to restore erectile function.

Microsurgeon and University of Melbourne Department of Surgery Professor, Christopher Coombs, and Monash Medical Centre urologist, Mr David Dangerfield, developed the new procedure.

Professor Coombs, who is also the paper's senior author, said these early results were promising. Those who could achieve erections again were extremely grateful -- as were their partners.

"We looked at sexual quality of life before and after. Regaining erectile function had a significant impact on quality of life and the way the men felt about themselves," Professor Coombs said.

"When they walk back in after 12 months you know if it's worked -- they're smiling and so are their partners. They think it's great."

Radical prostatectomy can injure the penis' nerves to the spongy tissue, the corpora cavernosa, which are responsible for initiating an erection.

The review followed 17 patients aged under 70 with severe or moderate post-prostatectomy erectile dysfunction, who had a sexual partner and undetectable PSA (Prostate Specific Antigen) levels.

Between March 2015 and October 2017, the men, whose median age was 64, underwent 'end-to-side' surgery to remove the sural nerve from the leg and graft it to the side of the46 larger femoral nerve in the thigh. New nerve fibres then grew along the sural nerve graft into the corpora cavernosa of the penis.

All patients tolerated the 2.5-4-hour procedure and were discharged after an overnight hospital stay. Erectile function was restored in three men within six months and nine within 12 months, a total of 71 per cent.

After a year, all 12 with restored erectile function had clinically relevant improvements in their sexual function, and 83 per cent were less bothered by their symptoms. Of the 12, seven did not require drugs to achieve erectile function "sufficient for satisfactory sexual penetration."

There were no side effects besides two minor wound infections and three patients with temporary quadriceps weakness which lasted one week.

End-to-side nerve grafting was first described in a medical journal in 1903 but is not known to have been used again until 1992, when

Erectile dysfunction drugs and flu vaccine may work together

By: The Ottawa Hospital
Source: Science Daily
web site: https://www.sciencedaily.com/releases/2018/05/180517102251.htm

A new study suggests that a common treatment for erectile dysfunction combined with the flu vaccine may be able to help the immune system mop up cancer cells left behind after surg47ery. The study, published in OncoImmunology, shows that this unconventional strategy can reduce the spread of cancer by more than 90 percent in a mouse model. It is now being evaluated in a world-first clinical trial.

"Surgery is very effective in removing solid tumours," said senior author Dr. Rebecca Auer, surgical oncologist and head of cancer research at The Ottawa Hospital and associate professor at the University of Ottawa. "However, we're now realizing that, tragically, surgery can also suppress the immune system in a way that makes it easier for any remaining cancer cells to persist and spread to other organs. Our research suggests that combining erectile dysfunction drugs with the flu vaccine may be able to block this phenomenon and help prevent cancer from coming back after surgery."

The current study investigated sildenafil (Viagra), tadalafil (Cialis) and an inactivated influenza vaccine (Agriflu) in a mouse model that mimics the spread of cancer (metastasis) after surgery. The researchers evaluated these treatments by counting the number of metastases in mouse lungs. They found an average of:

37 metastases with cancer cells alone
129 metastases with cancer cells and surgery
24 metastases with cancer cells, surgery and one of the erectile dysfunction drugs
11 metastases with cancer cells, surgery, one of the erectile dysfunction drugs and the flu vaccine

Dr. Auer is now leading the first clinical trial in the world of an erectile dysfunction drug (tadalafil) and the flu vaccine in people with cancer. It will involve 24 patients at The Ottawa Hospital undergoing abdominal cancer surgery. This trial is designed to evaluate safety and look for changes in the immune system. If successful, larger trials could look at possible benefits to patients.

"We're really excited about this research because it suggests that two safe and relatively inexpensive therapies may be able to solve a big problem in cancer," said Dr. Auer. "If confirmed in clinical trials, this could become the first therapy to address the immune problems caused by cancer surgery."

Using a variety of mouse and human models, Dr. Auer's team has also made progress in understanding how erectile dysfunction drugs and the flu vaccine affect cancer after surgery. Normally, immune cells called natural killer (NK) cells play a major role in killing metastatic cancer cells. But surgery causes another kind of immune cell, called a myeloid derived suppressor cell (MDSC), to block the NK cells. Dr. Auer's team has found that erectile dysfunction drugs block these MDSCs, which allows the NK cells to do their job fighting cancer. The flu vaccine further stimulates the NK cells.

"Cancer immunotherapy is a huge area of research right now, but we're still learning how best to use it in the time around surgery," said first author Dr. Lee-Hwa Tai, former postdoctoral fellow in Dr. Auer's lab and now assistant professor at the Université de Sherbrooke. "This research is an important step forward that opens up many possibilities."

Dr. Auer noted that although erectile dysfunction drugs and the flu vaccine are widely available, people with cancer should not self-medicate. Any changes in medication should be discussed with an oncologist.

First genetic risk factor for erectile dysfunction identified

By: Kaiser Permanente
Source: https://www.sciencedaily.com
web site: https://www.sciencedaily.com/releases/2018/10/181008183357.htm

For the first time, a team of researchers has found a specific place in the human genome that raises a person's risk of erectile dysfunction. The discovery is a significant advancement in the understanding of the genetics underlying erectile dysfunction. The study, "Genetic variation in the SIM1 locus is associated with erectile dysfunction," will be published the week of October 8 in the journal Proceedings of the National Academy of Sciences.

Erectile dysfunction, the inability to obtain and maintain an erection sufficient for sexual activity, is a common and costly condition of men of primarily middle and older ages. The disease is linked to many causes, such as neurological, hormonal and vascular factors.

Therapies based on these factors exist, but many men don't respond to them. Genetics also are suspected as a factor in about one-third of erectile dysfunction cases, but researchers have failed to make an association with any specific genomic locations until now.45

The new study found that variations in a specific place in the genome -- called a genetic locus -- near the SIM1 gene are significantly associated with an increased risk of erectile dysfunction. The researchers ruled out that the risk was due to other known risk factors for erectile dysfunction, such as body mass index, or differences in how men describe their erectile dysfunction. The study also demonstrated a biological role for the genetic location in regulating sexual function, strongly suggesting that these variations can cause erectile dysfunction.

"Identifying this SIM1 locus as a risk factor for erectile dysfunction is a big deal because it provides the long sought-after proof that there is a genetic component to the disease," said the study's lead author, Eric Jorgenson, PhD, a research scientist at Kaiser Permanente Northern California's Division of Research. "Identifying the first genetic risk factor for erectile dysfunction is an exciting discovery because it opens the door for investigations into new, genetic-based therapies."

The researchers conducted a genome-wide association study in two large and diverse cohorts to investigate genetic contributors to the risk of erectile dysfunction. The first cohort included 36,648 men from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort, which is part of the Kaiser Permanente Research Program on Genes, Environment and Health, a research program affiliated with the Kaiser Permanente Research Bank. The Research Bank supports external and internal investigation into a variety of health conditions and diseases and includes biospecimens from more than 320,000 consenting Kaiser Permanente members, as well as linked genetic, environmental and health data.

The GERA cohort included male members of Kaiser Permanente who completed a survey on their condition, had a clinical diagnosis of erectile dysfunction based on their electronic health records, and had used drugs or other erectile dysfunction treatments. The findings in the GERA cohort were then verified in a cohort of 222,358 men from the U.K. Biobank.

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