Adipose-derived stem cell therapy restores erectile function and promotes endogenous stem cell recruitment in a rat model of cavernous nerve injury.

Erectile dysfunction following non-nerve-sparing prostatectomy is prevalent. Although adipose-derived stem cells (ASCs) have shown therapeutic potential for erectile dysfunction, the underlying mechanisms remain unclear. To investigate the therapeutic effects of exogenous stem cells and their recruitment of endogenous stem cells in the context of postprostatectomy erectile dysfunction, we established a bilateral cavernous nerve injury (BCNI) rat model. The rats were divided into the sham surgery, BCNI + PBS, and BCNI+ASCs groups. Intracavernous pressure/mean arterial pressure ratios were compared between groups. In vivo imaging revealed ASC retention in the corpora cavernosa. Penile histomorphology and smooth muscle content were evaluated via Hematoxylin‒eosin and Masson staining. Immunohistochemistry, western blotting, and immunofluorescence were employed to quantify α-SMA, nNOS, caspase-3, vWF, Bax, Bcl-2, and SDF-1 levels and endogenous stem cell recruitment. Compared with the PBS control group, the ASC-treated group presented increased α-SMA, nNOS, and vWF expression and smooth muscle content, as well as reduced caspase-3, Bax, and Bcl-2 levels. Endogenous stem cell recruitment was observed in ASC-treated rats. Our findings demonstrate that exogenous ASCs injection suppresses apoptosis, enhances endothelial function, recruits endogenous stem cells, and alleviates erectile dysfunction in BCNI models. This study elucidates ASC-mediated mechanisms involved in erectile dysfunction recovery, providing insights for clinical translation.