Protein could heal erectile dysfunction after cancer surgery

After men have surgery to remove a cancerous prostate gland, up to 80 percent of them will lose the ability to have an erection because of damage to a critical nerve that runs along the prostate. New research from Northwestern University Feinberg School of Medicine shows the damaged nerve can be regenerated more quickly with a protein called sonic hedgehog delivered via a nanofiber gel.
The study, done with rats, showed the protein regenerated the damaged nerve twice as fast as it would have regenerated on its own. Speeding up the nerve healing is essential in order to prevent cell death in the penis and to preserve erectile function.
"This discovery about sonic hedgehog could be applicable not only to erectile dysfunction after prostate surgery but also when the cavernous nerve is damaged by diabetes, which also causes erectile dysfunction," said principal investigator Carol Podlasek, assistant professor of urology at Feinberg and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
The whimsically named sonic hedgehog, with a wink to the popular video game character, is a vital building block in the body that promotes nerve regeneration and directs the activity of many other proteins in the body.
"There is a tremendous need for a therapy to treat erectile dysfunction caused by cavernous nerve damage," Podlasek said. Men's quality of life after prostate cancer surgery is of greater concern, she noted, because men are being diagnosed at a younger age and live longer due to improved cancer therapies.
"The biggest concern for many men before they undergo surgery for prostate cancer is quality of life after surgery" Podlasek said. "It not only affects the men undergoing surgery but also their partners."
A recent survey of patients undergoing prostate cancer treatment showed that 45 percent of patients were most concerned with quality of life after surgery, 29 percent with extending their life and 13 percent with delaying disease progression.
"So for patients with prostate cancer, being able to have an erection and lead a normal life after treatment is very important," she noted.
Nonsurgical treatments for erectile dysfunction are only effective in a minority of patients with cavernous nerve damage, she noted.
The new study findings may also apply to any damaged peripheral nerve, such as the sciatic nerve or facial nerve, that needs this protein to maintain its structure, Podlasek said.
Podlasek presented her study findings at the recent American Urological Association 2010 Annual Meeting.
When a man's cancerous prostate gland is removed, the fragile cavernous nerve is often damaged when it is crushed or pulled during surgery. Once the nerve is damaged, smooth muscle cells quickly begin to die in the penis. The consequent scarring prevents the smooth muscle from relaxing and allowing blood to flow into its tissue to become erect.
"Once the smooth muscle starts to die off, you don't get an erection or you get less of an erection," Podlasek said. "The muscle damage is irreversible, so it's essential to heal the damaged nerve as quickly as possible."
Her goal is to regenerate the nerve more quickly to reduce the damage downstream in the penis. "When the nerve is functional, you get normal erectile function," she said. "It's two pieces to a puzzle."
For the current study, Podlasek combined sonic hedgehog with a nanofiber gel designed by study coauthor Samuel I. Stupp, the Board of Trustees Professor of Chemistry, Materials Science and Engineering, and Medicine at Northwestern. The gel traps the protein as it self-assembles into linear nanofibers, which resemble slender threads made out of gel. Podlasek applied the nanofibers to crushed cavernous nerves in rats. When she examined the nerves six weeks later, they had regenerated twice as fast as they would have on their own.
In previous research, Podlasek saw a 63 percent decrease in smooth muscle cell death in the penis when sonic hedgehog was restored to injured cavernous nerves. Also in previous research, she found that decreasing sonic hedgehog in the penis caused smooth muscle cells to die.

Dont’s Use Sexual Dysfunction Products With Undeclared Ingredients

The Department of Health strongly urged members of the public not to consume products for managing male impotence from unknown sources following notification from the Hospital Authority of two patients seriously affected by this kind of products found to have contained undeclared ingredients.
A DH spokesman said the affected men, aged 76 and 87 respectively, were found collapsed in late May. Both patients once required intensive care in Mainland China and Hong Kong respectively. They are now under treatment in public hospitals. One of them was still in serious condition and the other in stable condition. Their urine specimen found the presence of undeclared drug ingredients glibenclamide and sildenafil.
Investigation showed that both of them had taken a kind of brick red rhomboid tablets. Laboratory tests on the tablets found at their homes were confirmed to have contained glibenclamide and sildenafil.
Further enquiries revealed that the 76-year-old man had also taken an unnamed blue/white capsule while the 87-year-old had taken an unlabelled blue rhomboid drug. Both of these drugs were found to have contained sildenafil.
In the past two weeks, DH received notification of two other similar cases involving patients taking brown rhomboid tablets. They claimed that the drug that they had taken named "Jiu Bian Wang"(???).
The spokesman said that "Jiu Bian Wang"was not a registered pharmaceutical product in Hong Kong. DH’s earlier laboratory tests on "Jiu Bian Wang"revealed the presence of sildenafil and a high dosage of glibenclamide. DH’s further investigation into these cases is on-going.
Today’s notification brings the number of cases related to unregistered virility products to a total of 58, affecting 56 men aged between 39 and 87. Among them, two patients passed away.
The spokesman said that glibenclamide is a diabetic drug. It could cause nausea and gastro-intestinal upset. Improper use may cause a significant fall in blood sugar level with serious health consequence and even death
The side effects of sildenafil include low blood pressure, headache, vomiting, dizziness, and transient vision disturbances. It may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure of patients to dangerous levels. Improper use of sildenafil may pose serious health risks, especially for patients with heart problems.
Under the Pharmacy and Poisons Ordinance of Hong Kong, products containing sildenafil or glibenclamide must be registered before sale and can only be sold on a doctor’s prescription and under supervision of a pharmacist.
The spokesman urged the public not to consume virility products of unknown or unclear sources, because the efficacy, safety and quality of such could not be assured, the spokesman said.
"Members of the public and the trade who have in their possession similar products are urged to stop consuming or trading them immediately," he said.
They should destroy and dispose of the products or submit them to the Department’s Pharmaceutical Service at 3/F, Public Health Laboratory Centre, 382 Nam Cheong Street, Kowloon during office hours.
"People who have problems of sexual dysfunction should consult medical professionals for appropriate advice or medication," the spokesman said.

Stem Cell Research Could Aid Male Infertility

Male Infertility Treatment

Scientists have shown for the first time that sperm grown from embryonic stem cells can be used to produce offspring.
The experiment was carried out using mice and produced seven babies, six of which lived to adulthood.
The breakthrough, reported today, Monday July 10, in the academic journal Developmental Cell, helps scientists to understand more about how animals produce sperm. This knowledge has potential applications in the treatment of male infertility.
Karim Nayernia, who has just taken up a post as Professor of Stem Cell Biology at Newcastle University, led the research while in his previous position at Georg-August University in G� '� � ttingen, Germany, with Prof. Dr Wolfgang Engel and colleagues from Germany and the UK, including Dr. David Elliott from Newcastle University's Institute of Human Genetics.
Stem cells have the potential to develop into any tissue type in the body and could therefore be used to develop a wide range of medical therapies.
Prof Nayernia, of the Newcastle-Durham-NHS Institute for Stem Cell Biology and Regenerative Medicine*, and his team describe in their paper how they developed a new strategy for generating mature sperm cells in the laboratory using embryonic stem cells from mice. They then went on to test whether this sperm would function in real life.
The team isolated stem cells from a blastocyst, an early-stage embryo that is a cluster of cells only a few days old.
These cells were grown in the laboratory and screened using a special sorting machine. Some had grown into a type of stem cell known as 'spermatogonial stem cells', or early-stage sperm cells.
The spermatogonial cells were singled out, then genetically marked and grown in the laboratory. Some of them grew into cells resembling sperm, known as gametes, which were themselves singled out and highlighted using a genetic marker.
The sperm that had been derived from the embryonic stem cells was then injectd into the female mouse eggs and grown into early-stage embryos.
The early-stage embryos were successfully transplanted into the female mice which produced seven babies. Six developed into adult mice.
The work was funded by the University of G� '� � ttingen and the Germany Research Council (DFG).
Prof Nayernia, who originally hails from Shiraz in Southern Iran, said: "This research is particularly important in helping us to understand more about spermatogenesis, the biological process in which sperm is produced. We must know this if we are to get to the root of infertility.
"If we know more about how spermatogonial stem cells turn into sperm cells, this knowledge could be translated into treatments for men who are unable to produce mature sperm, although this is several years down the line. For example, we could isolate a patient's spermatagonial cells using a simple testicular biopsy, encourage them in the laboratory into becoming functional sperm and transplant them back into the patient."
The findings could also inform a field of stem cell research known as nuclear transfer, or therapeutic cloning, which aims to provide tailor-made stem cells to aid disease therapy and infertility. Sperm cells could potentially be created using this method.
Prof Nayernia and his team in Germany were the first in the world to isolate spermatagonial stem cells. The team was also able to show that some of these stem cells, called multipotent adult germline stem cells (maGSCs), turned into heart, muscle, brain and other cells.
Although previous studies have shown that embryonic stem cells grown in the laboratory can become germ cells that give rise to cells resembling sperm cells or gametes, this is the first time scientists have tested whether the gametes really work in real life.
Prof Nayernia added: "Spermatogonial stem cells are extremely promising and more research is needed to establish their full potential."

Health Canada Warns Against Ju Wang Erectile Dysfunction Treatment

Health Canada is advising consumers not to use Dr. Life and Chong Cao Ju Wang due to concerns about possible side-effects.
Dr. Life and Chong Cao Ju Wang are promoted for the treatment of erectile dysfunction.
Reason for Warning
The Hong Kong Department of Health warned consumers not to buy or use Dr. Life or Chong Cao Ju Wang because they were found to contain undeclared pharmaceutical ingredients. Dr. Life was found to contain an unauthorised substance with a structure similar to tadalafil (aminotadalafil) while Chong Cao Ju Wang was found to contain sildenafil.
Tadalafil and sildenafil are prescription drugs used in the treatment of erectile dysfunction, and should only be used under the supervision of a health care practitioner.
Possible Side-Effects
Unsupervised use of tadalafil or sildenafil by patients with heart disease can result in serious cardiovascular side-effects such as sudden cardiac death, heart attack, stroke, hypertension, chest pain and abnormal heartbeat. Additionally, use of tadalafil or sildenafil may be associated with other side-effects including temporary vision loss, seizure, prolonged erection, headache, flushing, nasal congestion and abdominal pain. Products containing tadalafil or sildenafil should not be used by individuals taking any type of nitrate drug (e.g., nitroglycerine) due to the risk of developing potentially life-threatening low blood pressure.

Cialis Improves Erectile Dysfunction Caused by Radiation Therapy for Prostate Cancer

Erectile Dysfunction Treatment With Cialis

Cialis� � (tadalafil) effectively treats erectile dysfunction in men treated with three-dimensional conformal radiation therapy for prostate cancer, according to the results of a study published in the International Journal of Radiation Oncology, Biology, Physics
Three-dimensional conformal radiation therapy (3D-CRT) refers to the use of a special CT scan and computer to better locate the prostate gland and more precisely aim the radiation. The use of 3D-CRT appears to reduce the chance of injury to nearby body structures, such as the bladder or rectum.
Since 3D-CRT can better target the area of cancer, radiation oncologists are evaluating whether higher doses of radiation can be given safely while achieving greater cure rates.
Preliminary data from several cancer programs suggests that the higher radiation dose delivered with 3D-CRT can reduce the rate of local cancer recurrence.
Erectile dysfunction is a potential side effect of radiation therapy for prostate cancer. The definition of erectile dysfunction used in the current study was "the inability to attain and/or maintain penile erection sufficient for satisfactory sexual activity."
To evaluate the effectiveness of Cialis in treating erectile dysfunction among prostate cancer patients treated with 3D-CRT, researchers in the Netherlands conducted a study among 60 men. All study participants reported normal erectile function before radiation therapy, and all had completed radiation therapy at least 12 months previously.
Cialis is a drug that acts in a similar manner to Viagra� � (sildenafil citrate), but is effective for up to 36 hours.
Study participants were given either Cialis (20 mg) or a placebo and instructed to take it when they chose, but at least once a week and no more than once daily. Study participants were not told whether they had been given Cialis or a placebo. After six weeks, study participants were switched to the other medication (from Cialis to placebo or from placebo to Cialis) for another six weeks. At the end of each six-week study period, participants completed a questionnaire about their sexual experiences.

• 67% of patients reported that their erectile function improved while taking Cialis. 20% of patients reported that their erectile function improved while taking the placebo.

• 48% of patients had successful sexual intercourse during treatment with Cialis. Only 9% of patients reported successful sexual intercourse during treatment with the placebo.

• Side effects that were more common during treatment with Cialis than during treatment with the placebo were headache, indigestion, and flushing. These side effects were transient and tended to be mild or moderate.

The researchers concluded that Cialis was effective and well tolerated. Among men experiencing erectile dysfunction after 3D-CRT for prostate cancer, roughly half reported successful sexual intercourse after treatment with Cialis.