A case report of pudendal arteries angioplasty with sirolimus drug-coated balloon and drug-eluting stent associated with intracavernous autologous peripheral blood mononuclear cells injection for untreatable vasculogenic erectile dysfunction

Abstract

Background Erectile dysfunction (ED) is a prevalent health problem that seriously impacts men's quality of life. The potential treatment of ED by percutaneous approach has emerged with valid angiographic results and a significant improvement in symptoms and quality of life. In addition, cell-based regenerative therapies aiming at enhancing neovascularization have been successfully performed with peripheral blood mononuclear cells (PBMNCs) in diabetic patients affected by critical limb ischaemia. Case summary We report a case of a young insulin dependent (ID) diabetic patients who suffered of severe vasculogenic erectile dysfunction associated with a poor response for more than 1 year to oral phosphodiesterase-5 inhibitors (PDE5i) and intracavernous (IC) phosphodiesterase type 1 (PDE1) therapy. At selective angiography of the pelvic district, a severe atherosclerotic disease of the internal iliac and pudendal artery was evident with absence of distal vascularization of the cavernous bodies. The patient was treated by mechanical revascularization with drug-coated balloon and drug-eluting stent placement associated with IC injection of autologous PBMNCs. Immediate and 1-year clinical and angiographic follow-up are described. Discussion Percutaneous revascularization with drug-coated balloon and drug-eluting stent associated with IC autologous PBMNCs cells injection is a safe and effective procedure to restore normal erectile function in diabetic patients affected by severe vasculogenic ED not responding to conventional oral drug therapies.

Rapamycin Suppresses Penile NADPH Oxidase Activity to Preserve Erectile Function in Mice Fed a Western Diet

“…mTOR inhibitors have been approved for use in drug eluting vascular stents and balloons by regulatory agencies. These have recently been used in the pre-penile arteries for treatment of vascular ED with promising results [ 57 , 58 ], which may represent a feasible way to locally target drug delivery. Results from the present study provide proof-of-principle that the nutrient- and energy-sensitive mTORC1/p70S6K pathway contributes to the oxidative burden that is involved in ED pathogenesis in the corpus cavernosum.…”

Regenerative therapies as a potential treatment of erectile dysfunction

“…Currently, most cell-based therapies are still in clinical trial phases I and II [ 8 ]. Additionally, there is little research on non-stem cell-based cell therapy, such as peripheral blood mononuclear cells [ 9 ]. Therefore, in this review, we only describe the past 20 years of research related to preclinical stem cell-based therapies for ED and their associated strengths and limitations.…”