Hu Zhenxing, Chen Keming, Dai Haitao, Lv Zhiyong, Li Jian, Yu Puguang, Feng Jiajing, Abdulkarem Alqaisi Mohammed, Wu Haifeng, He Rui, Li Guangyong
Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People's Republic of China.
Department of Urology, The First Affiliated Hospital of Yangtze University, Jingzhuo 434000, People's Republic of China.
Sex Med. 2024 May 28;12(2):qfae029. doi: 10.1093/sexmed/qfae029. eCollection 2024 Apr.
Although many clinical studies have shown that ROUX-en-Y gastric bypass (RYGB) surgery significantly improves metabolic syndrome-related erectile dysfunction (MED), the role and mechanism are unclear.
In this study we used a mouse model to explore how RYGB improves MED induced by a high-fat diet (HFD).
We established a mouse model of metabolic syndrome by feeding an HFD for 16 weeks. The mice were randomly assigned to the standard chow diet (SCD), HFD, or RYGB groups. Body weight, fasting blood glucose, plasma insulin, and total plasma cholesterol were analyzed. Erectile responses were evaluated by determining the mean systolic blood pressure and the intracavernosal pressure (ICP). Penile histologic examination (Masson's trichrome and immunohistochemical stain) and Western blot were performed.
Compared with the SCD group, the ICP in the sham group was significantly lower, and the ICP of the RYGB was significantly increased. Masson's trichrome and immunohistochemical staining showed that the content of endothelium and smooth muscle in the corpus cavernosum of mice with MED was significantly reduced. Western blot analysis showed a significant decrease in α-smooth muscle actin and a significant increase in osteopontin in penile tissue in the sham group, which was improved by RYGB surgery. Furthermore, RYGB significantly increased IRS-1/PI3K/Akt/eNOS phosphorylation.
In this study we explored the mechanism of bariatric surgery to improve erectile dysfunction associated with metabolic syndrome and provided a theoretical basis for clinical research.
First, we did not investigate the mechanism by which RYGB affects the IRS-1/PI3K/Akt/eNOS signaling pathway. Second, the effect of the IRS-1/PI3K/Akt/eNOS signaling pathway on the function of corpus cavernosum endothelial cells and smooth muscle cells remains to be investigated in cellular studies.
This study demonstrated that RYGB may not only improve metabolic parameters but also restore erectile function in MED patients. The mechanism of the therapeutic effect of RYGB may be reactivation of the IRS-1/PI3K/Akt/eNOS pathway.
尽管许多临床研究表明，Roux-en-Y胃旁路术（RYGB）能显著改善代谢综合征相关的勃起功能障碍（MED），但其作用和机制尚不清楚。
在本研究中，我们使用小鼠模型来探究RYGB如何改善高脂饮食（HFD）诱导的MED。
通过喂食HFD 16周建立代谢综合征小鼠模型。将小鼠随机分为标准饲料组（SCD）、HFD组或RYGB组。分析体重、空腹血糖、血浆胰岛素和总血浆胆固醇。通过测定平均收缩压和海绵体内压（ICP）评估勃起反应。进行阴茎组织学检查（Masson三色染色和免疫组织化学染色）及蛋白质免疫印迹法。
与SCD组相比，假手术组的ICP显著降低，而RYGB组的ICP显著升高。Masson三色染色和免疫组织化学染色显示，MED小鼠海绵体内内皮细胞和平滑肌含量显著减少。蛋白质免疫印迹分析显示，假手术组阴茎组织中α-平滑肌肌动蛋白显著减少，骨桥蛋白显著增加，而RYGB手术可改善这种情况。此外，RYGB显著增加了IRS-1/PI3K/Akt/eNOS磷酸化水平。
在本研究中，我们探究了减重手术改善代谢综合征相关勃起功能障碍的机制，为临床研究提供了理论依据。
第一，我们未研究RYGB影响IRS-1/PI3K/Akt/eNOS信号通路的机制。第二，IRS-1/PI3K/Akt/eNOS信号通路对海绵体内皮细胞和平滑肌细胞功能的影响仍有待细胞研究进行探究。
本研究表明，RYGB不仅可以改善代谢参数，还可以恢复MED患者的勃起功能。RYGB治疗作用的机制可能是重新激活IRS-1/PI3K/Akt/eNOS通路。
