Background and Animal Studies
Background and Animal Studies
Diabetes is an increasing disease worldwide, and it is estimated that the number of cases will rise to 300 million globally by 2025. Erectile dysfunction (ED) is a common complication of diabetes and is responsible for a decreased quality of life in diabetic men, who have a three-fold higher risk of ED development compared with healthy individuals. ED may also be the initial presentation of diabetes in 12% of patients subsequently diagnosed with this pathology. In individuals with diabetes, ED occurs at an earlier age, is more severe and increases with disease duration, being approximately 15% at 30 years of age and rising to 55% at 60 years of age. In individuals with diabetes, ED has been associated with the underlying neuropathic condition. However, it seems that as a result of their location, cavernosal vascular endothelial cells (ECs) are the primordial organ affected by this disease. In fact, metabolic derangements induced by hyperglycaemia and increased oxidative stress disable penile EC functional response in order to maintain homeostasis, impairing the endothelium regulatory role on the modulation of vascular- and smooth-muscle (SM) contractile tone, which is crucial for normal erectile functionality. This loss of endothelial ability to vasodilate in response to local and systemic changes is referred to as endothelial dysfunction and recognised as a key feature of diabetes-associated ED. Ageing may also affect the structural and functional properties of ECs and SM, leading to vascular dysfunctions.
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