An updated narrative review on revolutionizing erectile dysfunction treatment: the crucial role of trophic factors in Adipose-Derived stem cell therapy
Abstract
Erectile dysfunction (ED) is a pervasive condition projected to affect some 322 million men worldwide by 2025, profoundly impairing quality of life and psychosocial well‑being. Current therapies-most notably phosphodiesterase‑5 inhibitors and mechanical devices-offer only transient, symptomatic relief and do not repair the underlying vascular, smooth muscle, and neural degeneration driving ED, particularly in diabetic and neurogenic subtypes. Emerging non‑cellular modalities (e.g. low‑intensity pulsed ultrasound or shockwave therapy) likewise lack demonstrated long‑term safety and durable efficacy. Adipose‑derived stem cell (ADSC) therapy has emerged as a promising regenerative strategy. In preclinical models, ADSCs exert paracrine effects-secreting trophic factors (VEGF, IGF‑1, SDF‑1, NGF) and exosomal microRNAs-that stimulate angiogenesis, smooth muscle restoration, and nerve regeneration. Innovative delivery platforms (thermosensitive hydrogels, size‑controlled spheroids, magnetic guidance) and genetic enhancements (iNOS or PEDF overexpression) further improve cell retention and functional outcomes. Early-phase clinical trials confirm ADSC safety and suggest improvements in International Index of Erectile Function scores, but are limited by small cohorts, heterogeneous protocols, and short follow‑up. Critical gaps persist that hinder translation to routine practice: the long‑term safety and efficacy of ADSC therapy remain unestablished; retention of transplanted cells in…
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