Disease Modifying Treatment Using Combined Shockwave Therapy and Platelet Rich Plasma In Microvascular Erectile Dysfunction

项目摘要 与高血压和糖尿病相关的微血管勃起功能障碍正变得越来越普遍 在西方世界人口老龄化的背景下。尽管有几种有效的治疗方法可以治疗ED，但没有疾病 改良干预可改善勃起功能障碍的基本病理生理机制 是可用的。冲击波治疗(SWT)是一种新的、无痛的、非侵入性的实验策略，它可以引起 血管系统的生物反应，包括刺激内源性修复能力和 新血管的形成。富含血小板血浆(PRP)是一种促进组织生长的替代疗法 α颗粒中储存的多种生长因子和细胞因子的释放介导的再生 血小板。虽然SWT和PRP已经作为单一疗法在临床试验中被研究为ED，但联合使用 还没有被调查。我们已经证明了短期使用SWT对患有ED的男性患者的安全性 随机优势试验。我们还在一项正在进行的临床试验中证明了PRP的安全性。我们相信， SWT和PRP的作用是相加的。这一提议背后的工作假设是，SWT和PRP将 作为勃起功能障碍的添加剂，改善主观勃起功能评分，客观阴茎血流动力学，促进 阴茎内皮功能。我们将对30名轻度到中度的男性进行单中心开放标签试验 ED将接受两次海绵体内注射(相隔6周)，其间每周进行SWT。我们会 用国际勃起功能指数评分(Aim1)评价勃起功能改善情况。我们 将通过评估确定阴茎SWT PRP改善微血管ED的机制(目标2) 阴茎血管血流和内皮功能。SWT PRP是一种很有前途的尖端技术，它将 可能对急诊室的管理做出重大贡献。拟议的研究是一项试验性和可行性的临床研究。 在人体上进行的试验，将获得初步数据，收集与招募有关的可行性数据，并 保留，并为与预防和/或治疗ED有关的更大规模的临床试验奠定基础， NIDDK任务范围内的疾病。

Project Summary Microvascular erectile dysfunction associated with hypertension and diabetes is becoming increasingly common in an aging population of the Western world. Despite several effective treatments available for ED, no disease modifying intervention capable of improving the underlying pathophysiology of ED and restoring erectile function is available. Shock wave therapy (SWT) is a novel, painless, non-invasive experimental strategy which elicits biological responses in the vascular system, including stimulation of endogenous reparative capacity and formation of new blood vessels. Platelet-rich plasma (PRP) is an alternative therapy to promote tissue regeneration mediated by the release of several growth factors and cytokines stored in the alpha granules of platelets. Although SWT and PRP has been investigated for ED in clinical trials as monotherapy, the combination has not been investigated. We have shown the safety of using SWT over a short duration for men with ED in a randomized superiority trial. We also have shown safety of PRP in an ongoing clinical trial. We believe that the action of SWT and PRP is additive. The working hypothesis underlying this proposal is that SWT and PRP will be additive for ED and improve subjective erective function scores, objective penile hemodynamics and promote penile endothelial function. We will conduct a single center open label trial with 30 men with mild to moderate ED who will receive two intracavernous injections of PRP (6 weeks apart) with weekly SWT in between. We will evaluate improvement in ED using International Index of Erectile Function score at 3 and 6 months (Aim1). We will determine the mechanism by which penile SWT + PRP improves microvascular ED (Aim 2) by evaluating penile vascular flow and endothelial function. SWT + PRP is a promising, cutting edge technique, which will likely contribute significantly towards management of ED. The proposed study is a pilot and feasibility clinical trial conducted in humans that will acquire preliminary data, collect feasibility data related to recruitment and retention, and lay the foundation for a larger clinical trial related to the prevention and/or treatment of ED, a disease within the mission of NIDDK.