Wednesday, March 18, 2020

Next Generation & the Future of Erectile Dysfunction Treatments

Erectile dysfunction also synonymously known as ED affects nearly half of men between the ages of 40 and 70 to some extent. Vascular diseases interrelated with aging, hyperlipidemia, smoking, diabetes as well as hypertension, are often linked to erectile dysfunction. Furthermore, injury to cavernous nerves in the penile region “comprises an appreciable number of ED cases.” ⁶ Other causes of erectile dysfunction include but are not limited to endocrine disorders, as well as fibrosis of the penile tissue and corporal smooth muscle.¹¹ Overall both vasculogenic and neurogenic erectile dysfunctions are linked to the loss of normal cellular function or cell death (apoptosis).

Oral medications such as phosphodiesterase-5 inhibitors (PDE5is), have clear benefits, and are typically first-line treatments in regards to erectile dysfunction, however their actions are short lived.⁶ Lifestyle changes and injections are also typical first line treatment options for the management of complex cases of erectile dysfunction. Most recently scientists and physicians have been focusing on new next generation novel therapy options as a way to restore natural sexual function; one such treatment option includes Stem Cell based Bioactive Factor Therapy.

Stem-cell-based therapies focus on the management of erectile dysfunction “through the protection of the threatened host cells via immunomodulatory effects, and the provision of trophic factors or gene delivery.”¹¹ In recent years, a number of research studies related to the progress of stem cell-based erectile dysfunction therapy have been published. This is yielding strong evidence supporting the concept that stem-cell-based bio-active therapy is potentially the next generation therapeutic approach for erectile dysfunction. Furthermore, research studies conducted have taken into account a large spectrum of stem cells, including mesenchymal stem cells, tissue as well as muscle -derived stem cells for further investigation in regards to vascular, neural, endothelial or smooth muscle regeneration in animal models for erectile dysfunction.

What are Mesenchymal Stem Cells?

Stem cells are cells that differentiate into smooth muscle cells, neurons, endothelial cells and other types of varying cells. Stem cells by definition have the capability of self-renewal, meaning that they can make copies of themselves for an indefinite period, and differentiate into a variety of phenotypes.¹^,² Stem cells are defined by their “capacity for both self-renewal and directed differentiation. Thus, they represent great promise for regenerative medicine.” Stem cells can be categorized as either embryonic stem cells (ESCs) or adult stem cells (ASCs). Embryonic stem cells (ESCs) are acknowledged as an example of pluripotent cells.⁶ While multipotent stem cells include mesenchymal stem cells (MSCs) as they “are capable of self-renewal, and they can differentiate into any cell type within their germ layer”.⁴

Stem cells have diverse properties that make them potentially viable for utilization in various disease treatments. In particular, adult MSCs are “multipotent cells that undergo self-renewal and differentiation” as well as express specific surface markers.¹³ MSCs can be derived from different sources within the body, including adipose tissue, bone marrow as well as the umbilical cord membrane. ¹³, ¹² Historically, MSCs were founded by a researcher named Friedenstein through the conduction of studies on the bone marrow although MSCs can be isolated from other adult tissues including adipose tissue. ⁷^,⁵ The word “Stem Cells” more correctly known as “Mesenchymal Stem Cells” (MSCs) were termed MSCs secondary to their innate ability to duplicate while maintaining the attribute of multi-potential lineage.

MSCs “contain growth factors, signaling lipids, mRNAs, and regulatory miRNAs, which are involved in tissue repair as paracrine mediators.” ¹³^,¹⁴ Research studies have also suggested that exosomes released by MSCs may aid erectile dysfunction linked to diabetes through anti-fibrotic mechanisms, preventing cell death as well as increasing smooth and endothelial muscle content. ¹⁵^,¹⁸

What are Bioactive Factors and EVs?

MSCs are able to secrete soluble “Bioactive Factors” which aid in modulating the immune system, improve the standard rate of healing injured tissues and reduce inflammation. Stem Cell Bioactive Factors consist of nanoparticles which are released from the membranes of Mesenchymal Stem Cells (MSCs). These nanoparticles contain over “200 Growth factors, Cytokines and Nucleic Acids which support healthy cell-to-cell communication and are responsible for the therapeutic effects observed in regenerative medicine.”

EVs or extracellular vesicles are membrane-packed vesicles that are secreted by MSCs. ⁹ EVs have been demonstrated to perform a critical role in cell-to-cell communication and important processes such as immune responses, homeostasis maintenance, and more. ⁸^,⁹

Microvesicles, an important EV, may “change functional target cells by delivering intracellular proteins”; for example, MVs released from endothelial cells can promote the regeneration through transfer of growth factors and their activators. ¹² MSC-derived EVs (MSC-EVs) based stem cell therapies are easier to manage and safer “due to their inability to directly form tumors.” ¹⁰

Mesenchymal Stem Cell’s Bioactive Factors

Bioactive Factors demonstrate numerous advantages when compared to Mesenchymal Stem Cells:

Bioactive Factors do not contain DNA as they have no cells therefore there is no risk of a malignant transformation.
Bioactive Factors contain nano-particles which can travel systemically without the risks of clumping.
Bioactive Factors have the ability to cross the Blood Brain Barrier (BBB) and are able to exert their neurotrophic effects.
MSCs can be perceived as “foreign” by our own immune system (both innate and adaptive), however Bioactive Factors are able to evade immune response.

Essentially Bioactive Factors exert far more therapeutic effects than Mesenchymal Stem Cells could.

Therapeutic Effects of Stem Cell Bioactive Factors

Growth factors, Cytokines and Nucleic Acids within Stem Cell Bioactive Factors are catalysts for regeneration as they contribute to tissue and organ repair, alter inflammation, aid in neural communication, improve mitochondrial viability and participate in the alteration of aging cells. Overall Bioactive Factors derived from Stem Cells aid the body in repairing damaged tissues and injuries.

Stem Cell Bioactive Factors have been utilized by Medical Professionals for a number varying aspects including but not limited to soft tissue repair, and restoring sexual wellness. In regards to men’s sexual health Stem Cell Therapy rejuvenates, repairs and regenerates damaged penile tissues, aiding in the restoration of erectile function which may contribute to the elimination the need for long term reliance on drugs.

Some Examples of Bioactive Factors

VEGF (Vascular Endothelial Growth Factors): Aids in the creation of new blood vessels, and in the generation of muscles through bypassing blocked vessels.
PDGF-BB (Platelet Derived Growth Factor Sub Unit B): Stimulates the healing of soft as well as hard tissues.
TGF B3 (Transforming Growth Factor B3): Aids in the conversion of inflammatory T cells into anti-inflammatory Regulatory T cells.
GDF 15 (Growth Differentiation 15): Regulates inflammation and aids in cell repair as well as growth.

How Boston Medical Group Sources Bioactive Factors

Boston Medical Group utilizes Bioactive Factors produced from an FDA-registered Tissue Banks which follow strict GMP guidelines as well as implement and maintain FDA regulations. The Tissue Bank sources from the highest quality donors and harvests from the healthiest part of the placenta in order to produce viable MSCs from which secreted Bioactive Factors are collected at the highest point potency. Upon the completion of manufacturing, each batch is sent for third party testing regarding microbiology and other safety protocols.

Clinic Trials Regarding Stem Cell Therapies and Erectile Dysfunction

Stem Cell Therapy can utilize varying types of stem cells including MSCs. Stem cells may also treat erectile dysfunction by supporting penile tissue through paracrine or hormone effects such as the “release of repair cytokines triggering endogenous mechanisms of regeneration separate from the trans-differentiation of stem cells into different cell types.” ¹⁴ Furthermore MSCs do not necessarily need to be engrafted within tissue to create a functional and structural response to the therapy administered.

Phase one studies in humans have shown “results in terms of tolerability, safety, and efficacy of use of stem cell transplant for the treatment of erectile dysfunction.” ¹⁸ Recent studies have also suggested that the combination Shock Wave Therapy and Stem Cell Therapy may decrease cell destruction within the penile corpora region as well as promote the growth of new blood vessels. ¹⁹

A literature review from ScienceDirect regarding the efficacy of Stem Cell Therapy revealed that five previously completed human clinical trials did show promise for Stem Cell Therapy as “being a restorative treatment option for erectile dysfunction”.²⁰ The five studies included in the literature review utilized different types of stem cells, including various mesenchymal stem cells (MSCs). A total of 61 patients were included in the give studies, with mean ages of men being between 50 and 70 years. The literature review found that the majority of the five studies suggested improvement in erectile function and vascular flow in the penile region due to stem cell therapy without the report of serious adverse events occurring during the follow-up period. ²⁰

Stem Cell Therapy may be a paradigm shift in the growing number of treatment options available for erectile dysfunction. Stem Cell Therapy has been recognized for its therapeutic properties in regards to aiding in treatment for various conditions including erectile dysfunction. Boston NextGen Therapy embraces the latest in advanced technologies to help men restore erectile function without the use of drugs or the long term reliance on drugs. Boston Medical Group utilizes treatment protocols which are personalized to the individual’s conditions and may combine regimens such as shockwave therapy called RejuvaPulse Therapy, BostonPRP Injections and Stem-Cell Bioactive Factors. Thanks to a vast amount continuing research and development, Boston Medical Group physicians have culminated the most efficacious treatment protocols and continue to be the market leader in the field Erectile Dysfunction.

Boston Medical Group’s Optimum Regenerative Solution

Boston Medical Group utilizes the latest in next generation revolutionary treatment options for Erectile Dysfunction while upholding to GMP guidelines, and the utmost standards or requirements regarding the utilization of FDA registered tissue procurement organizations for Stem Cell Therapy. Boston Medical Group utilizes Bioactive Factors and EVs secreted from the membranes of placental-derived MSCs (Mesenchymal Stem Cells) which possess more than 200 growth factors as well as other immune factors which can render considerable therapeutic benefits, especially in the field of Regenerative Medicine***.

References

Figure 1. https://www.wjgnet.com/1948-0210/full/v11/i9/618.htm#F1

Article source here: Next Generation & the Future of Erectile Dysfunction Treatments

Monday, March 9, 2020

Viagra Not Working? Here’s What You Can Do

Viagra Not Working? This Guide Can Help You

Once categorized as a psychological disorder, erectile dysfunction is now regarded as a physiological ailment through numerous coherent studies. According to Harvard Health Publishing, impotence is more common than expected, with a prevalence of up to 22% in American men, mostly in the older age groups.¹ However, younger men are also at risk, considering the fact that the leading causes of ED are chronic diseases, capable of interrupting regular blood flow and nerve functionality, with examples including; diabetes, hypertension, multiple sclerosis, as well as hormonal imbalance.¹

Although very difficult for many men to accept and admit to this condition, we are lucky to live in an age of pharmaceutical furtherance, providing us with medication that works for treating ED. Sildenafil, sold as the brand name Viagra among other oral medication in pill form were the first to rush to rescue men dealing with impotence. However, similar to several other medications, there is no guarantee that Viagra will work, so the question we are asking today is what should we do when Viagra doesn’t work?

Possible Health Reasons Why Your Viagra is Not Working

A healthy erection is dependent on an uninterrupted blood flow to the penis, through the penile cavernous arteries, to fill the corpora cavernosa, therefore, causing the stiffening of the penile shaft. An erection is initiated with sensory and mental stimulation, with an emphasis on proper neural functioning. We cannot ignore performance anxiety and fatigue; however, physical irregularities are the primary causes of ED, therefore, medications such as Viagra are prescribed to push past the abnormal blood circulation and increase blood flow to the cavernous arteries, working as a vasodilator. Besides Viagra’s prolonged onset of action, the crisis many users face revolves around the ineffectual aspect of sildenafil and its recommendations against use by men with severe cardiovascular ailments.⁴ Viagra just doesn’t work for some men.

Low-Testosterone Levels

Testosterone is the key hormone produced by the Leydig cells of the testicles and is responsible for the normal growth and development of male organs and for maintenance of other sexual characteristics. During their late twenties, men begin to encounter the decline and imbalance of hormones, specifically testosterone. Depletion of testosterone, which is referred to as andropause is accompanied by several symptoms³:

Increased body fat and loss of muscle mass
Depleted bone mass and energy levels
Hair loss
Disturbed sleep patterns and mood swings
Erectile dysfunction.

Such imbalance has a significant role in sexual desire and performance. Although, testosterone is an essential component of a healthy sex life, it is not a requirement for normal and consistent erections. Viagra cannot replace or maintain testosterone levels, meaning Viagra (and other Sildenafil brand names) will not work as a replacement for the natural urge or desire for sex. Patients should seek testosterone replacement or hormonal therapy instead.³

STDs

Another topic of emphasis is around the use of ED medication and contracting an STD. ED medication does not work as a protective barrier against STDs and everyone should practice safe sex regardless. Meanwhile, certain STDs can possibly lead to erectile dysfunction, making ED medication less effective. An example of the mentioned scenario is an individual who contracted Chlamydia, and did not seek proper medical attention, allowing the bacteria to grow and infect the prostate gland, leading to prostatitis. It is very useful to know ED medication cannot be used and will not work for protection against STDs, and everyone should always practice safe sex

Diabetes

ED is very prominent in men with diabetes. The incidence rate of ED increases with age from 5% in men age 20 to 75% in men over age 65.⁴ The primary cause of impotence in diabetic men is due to the decrease in the blood flow and nerve damage in the penile area as a consequence of diabetes. Many diabetic patients have successfully been treated with Viagra since 1998, followed by Cialis, Levitra, and Stendra ever since. However, diabetic patients might also fail to enjoy the therapeutic advantages of such oral medication after building resistance or from the very first pill. Around 50 percent of men with Type 1 diabetes and 60 percent of Type 2 diabetic patients have reported improved erectile conditions.⁴

Meanwhile, a huge portion of diabetic men are left untreated or unresponsive to Viagra, primarily due to the damaged blood vessels and nerves caused by diabetes. The absorption and systematic flow of the medicine after ingestion is also altered in diabetic patients, making it more difficult for the drug’s action mechanism to work its biochemical effect. Many diabetic patients will report little or no difference in erection habits even after using Viagra and similar products.⁴

The Root of Your ED is Psychological

As mentioned before, ED is also impacted by psychological factors. Anxiety and depression is very popular among men who report erectile dysfunction or similar problems. Psychological pressure can influence sexual stimulation, causing discomfort or lack of response to stimuli.⁵ Performance anxiety and stress may be responsible for the lack of effect that Viagra has in many men. It is equally important to be comfortable mentally as well as physically during sexual activities for Sildenafil-based medications to work.

Using a Low Dose or Using it Incorrectly

It is very important to realize that the correct method of use and dosage is the key to Viagra working as desired.⁷ This translates to taking Viagra or Levitra at least an hour before engaging in sexual activity for it to be working properly. The drug must also be taken on an empty stomach preferably or avoiding a heavy meal prior to taking the medication, in order to maximize uptake.

Alcohol intake must be reduced to a minimum, since alcohol decreases the blood flow and circulation, making Viagra less effective. Sufficient stimulation is also another recommended approach to working the most out of your ED medication.⁶

Typically, doctors prefer to start the patient with the lowest dose, since daily administration can lead to improved blood flow to the penile area on a regular basis. Also, this method of administration may guide the doctors to determining the appropriate amount needed to treat ED, without the risk of overdosing. Similarly, a very low dosage might also not have the desired impact on the erections, causing many users to seek other treatment options that actually work, without trying to adjust the prescribed dose of the current medication with the help of a medical professional.

Giving Up Early On It

It is logical and recommended to try a certain medication a few times before moving on to the next if it’s not working at first. The chances of error and incorrect use might make it difficult to see results after first use, so, the user must be patient and allow several attempts.⁶ A correct explanation for lack of results after the initial use could be the inappropriate dose, taking Viagra on a full stomach, or expecting it to work immediately after ingestion.

What ED Treatment Options Are Out There?

As mentioned, we do live in a world driven by pharmaceutical advancements, and there is no reason to give up hope finding treatment for such a common disorder. Multiple treatment options are available with relatively higher or lower success rate to Viagra and similar products, but, it is important to realize some individuals might be more responsive to certain treatment options compared to others, due to certain underlying conditions, physiological differences, or severity of their ED.⁷

Other Options For Treating ED When Viagra Won’t Work

ICP

Considered a very effective but often under-utilized treatment for Erectile Dysfunction, ICP involves an injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis, using an auto-applicator. This combination causes an expansion of the penile arteries and penile tissues, resulting in increased blood flow to the penis. An erection typically develops within minutes. The erection feels perfectly natural and normal; however, it will not subside after ejaculation until the effect of the medicine wears off. In rare cases side-effects of ICP include penile bruising, pain or tenderness, scarring, and a prolonged erection (known as a priapism). Boston Medical Group physicians have developed a unique approach to this method that has been effective for thousands of patients. Because it is applied locally and is non-systemic, it is often recommended for men with diabetes, heart conditions, high blood pressure or other illnesses. In the last 15 years ICP has re-emerged as a treatment option for men who do not respond to well-known oral medications for ED. Many men prefer to use ICP over other methods given its record of safety, quality, and highly predicable results.

Hormonal Replacement Therapy

Some men experience a condition called andropause, similar to menopause in women, which can be caused by low testosterone. Symptoms can include, but are not limited to, feelings of sluggishness, fatigue, poor sleeping habits, weight gain, low sex drive, or erectile dysfunction. For the appropriate candidate, hormonal replacement therapy can be valuable in reversing these symptoms and even improve libido (sexual drive).

Blood tests are required for the purpose of diagnosis, monitoring the treatment effectiveness, as well as any other adverse side-effects.

Sublingual Tablets

For men who can otherwise tolerate the side-effects of Oral Medications but want a more potent and faster acting solution. These tablets have the same contraindications and side effects as standard Oral Medications but due to faster absorption they have a faster onset of response.

PRP

Platelets are components of blood that contains a number of growth factors which have the ability to promote the repair and healing of damaged or injured tissue throughout the body.

Platelet-Rich Plasma is prepared by taking a small sample of blood and subjecting it to centrifugation (spinning the blood sample at a high rate of speed), which separates red blood cells and white blood cells from the remaining plasma. The remaining plasma is “packed” with platelets that remain behind, hence the term Platelet-Rich Plasma (PRP).

Once PRP is collected and injected into the “injured” tissue, PRP releases growth factors which then trigger the natural healing process.

Penile Surgery

Penile surgery and such procedures are often termed as last resort, and are advised to be considered only after all other treatment options are exhausted without success.

Penile Prosthesis

In this surgical procedure, semi-rigid rods or inflatable prostheses are inserted in the erectile tissue, after removal of the mentioned tissue. The placement of an implant requires permanent injury and adjusting of the erectile tissue of the penis, and this makes the treatment irreversible, without the guarantee of success.

Arterial and Venous Surgeries

Approximately 2% to 5% of patients are candidates for vascular reconstructive surgery, which includes arterial bypass and venous ligation. Risks include those related to other major surgical procedures. Boston Medical Group physicians do not perform these surgeries.

Non-Invasive Treatment

With the introduction of ED treatments, some had to find a way to be treated without the use of medication or surgery. Non-invasive treatment options are available to those who prefer long-term results.

Rejuvapulse Therapy

RejuvaPulse is a completely non-invasive therapy that
uses pulsed sound waves to deliver energy to targeted penile tissue which activates the body’s own healing and regenerative properties. This results in healthy, new blood vessels, increased blood flow, and stronger, firmer erectile performance. RejuvaPulse is generically referred to as Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT) or simply Shockwave Therapy.

RejuvaPulse therapy breaks up micro-plaque; repairs aged blood vessels, and stimulate the growth of new vessels, a process called neovascularization. After a series of six to twelve treatments of about 20 minutes each, RejuvaPulse therapy results in penile rehabilitation, regeneration, and rejuvenation.

Vacuum Suction Device

A VSD is a battery or manually-operated cylindrical pump which fully encloses the penis. When activated, it creates a vacuum by sucking air out of the sealed chamber, which draws blood to the penis. A firm rubber ring is placed around the base of the penis to trap the blood in the erectile chamber, which keeps the penis firm. Disadvantages can include incomplete erections, discomfort, and the time required for operation, but VSDs are often valuable when used along with other treatments, like ICP.

Psychological Help And Other Wellness Treatments

Sex Therapy

Sex therapy is often the treatment of choice for patients with psychological Erectile Dysfunction. It demands the cooperation of the sexual partner, multiple sessions, and an experienced sex therapist for the best results.

Despite the psychological and physiological factors affecting impotence, it is very important to try different treatment options and find the right fit with the help of a doctor. Many factors such as diet, weight, incorrect use, low dosage, Low-T, diabetes, and giving up early will make it slightly difficult to experience the best of the available treatment options.² It is vital to follow the correct instruction for use, in order to maximize the effect of medication.

Diabetes and Low testosterone both affect the body in ways which might interfere with the action mechanism of certain medical products. Sexual desire, which is regulated by hormonal balance and testosterone, is an important factor which pills like Viagra and Cialis cannot regulate. Be more attentive to underlying conditions which make it difficult for Viagra and similar products to work.² As mentioned before, if Viagra doesn’t work, there are plenty of other treatment options available. Contact Boston Medical Group to learn more about the multiple treatment options provided for erectile dysfunction, premature ejaculation, and low testosterone levels.

Sources:

Article source here: Viagra Not Working? Here’s What You Can Do