TY - JOUR
T1 - Adipose tissue-derived stem cell therapy for cavernous nerve injury-induced erectile dysfunction in the rat model
T2 - A systematic review and meta-analysis using methodological quality assessment
AU - Park, Hyo Jung
AU - Jeong, Hyunsuk
AU - Park, Yong Hyun
AU - Yim, Hyeon Woo
AU - Ha, U. Syn
AU - Hong, Sung Hoo
AU - Kim, Sae Woong
AU - Kim, Na Jin
AU - Lee, Ji Youl
N1 - Publisher Copyright:
© 2019 by the Korean Society for Stem Cell Research.
PY - 2019
Y1 - 2019
N2 - Background and Objectives: Few studies were evaluated the effect of blindness on outcome in animal models, though a potential effect of blinding has been reported in clinical trials. We evaluated the effects of adipose tissue-derived stem cells (ADSCs) on cavernous nerve injury (CNI)-induced erectile dysfunction (ED) in the rat and examined how proper blinding of the outcome assessor affected treatment effect. Methods and Results: We searched in Pubmed, EMBASE, Cochrane and Web of Science databases from inception to January 2019. We included CNI animal model, randomized controlled experiments, and ADSC intervention. Erectile function and structural changes were assessed by intracavernous pressure and mean arterial pressure (ICP/MAP) ratios, neuronal nitric oxide synthase (nNOS) levels, cavernous smooth muscle and collagen (CSM/collagen) ratios, and cyclic guanosine monophosphate (cGMP). Results: Nineteen studies were included in the final meta-analysis. The ICP/MAP ratio of the ADSC treatment group increased compared to the control group (SMD=1.33, 95%CI: 1.11~1.56, I2=72%). The nNOS level (SMD=2.29, 95%CI: 1.74~2.84, I2=75%), CSM/collagen (SMD=2.57, 95%CI: 1.62~3.52; I2=85%), and cGMP (SMD=2.96, 95%CI: 1.82~4.10, I2=62%) were also increased in the ADSC treatment group. Preplanned subgroup analysis was conducted to explore the source of heterogeneity. Five studies with blinded outcome assessment were significantly less effective than the unblinded studies (SMD=1.33, 95%CI: 0.86~1.80; SMD=1.81, 95%CI: 1.17~2.46, respectively). Conclusions: ADSCs might be effective in improving erectile function and structural change in CNI-induced ED. However, non-blinded outcome assessors might cause detection bias and overestimate treatment efficacy. Therefore, the ADSC efficacy must be further evaluated with a rigorous study design to avoid bias.
AB - Background and Objectives: Few studies were evaluated the effect of blindness on outcome in animal models, though a potential effect of blinding has been reported in clinical trials. We evaluated the effects of adipose tissue-derived stem cells (ADSCs) on cavernous nerve injury (CNI)-induced erectile dysfunction (ED) in the rat and examined how proper blinding of the outcome assessor affected treatment effect. Methods and Results: We searched in Pubmed, EMBASE, Cochrane and Web of Science databases from inception to January 2019. We included CNI animal model, randomized controlled experiments, and ADSC intervention. Erectile function and structural changes were assessed by intracavernous pressure and mean arterial pressure (ICP/MAP) ratios, neuronal nitric oxide synthase (nNOS) levels, cavernous smooth muscle and collagen (CSM/collagen) ratios, and cyclic guanosine monophosphate (cGMP). Results: Nineteen studies were included in the final meta-analysis. The ICP/MAP ratio of the ADSC treatment group increased compared to the control group (SMD=1.33, 95%CI: 1.11~1.56, I2=72%). The nNOS level (SMD=2.29, 95%CI: 1.74~2.84, I2=75%), CSM/collagen (SMD=2.57, 95%CI: 1.62~3.52; I2=85%), and cGMP (SMD=2.96, 95%CI: 1.82~4.10, I2=62%) were also increased in the ADSC treatment group. Preplanned subgroup analysis was conducted to explore the source of heterogeneity. Five studies with blinded outcome assessment were significantly less effective than the unblinded studies (SMD=1.33, 95%CI: 0.86~1.80; SMD=1.81, 95%CI: 1.17~2.46, respectively). Conclusions: ADSCs might be effective in improving erectile function and structural change in CNI-induced ED. However, non-blinded outcome assessors might cause detection bias and overestimate treatment efficacy. Therefore, the ADSC efficacy must be further evaluated with a rigorous study design to avoid bias.
KW - Adipose tissue-derived stem cell
KW - Erectile dysfunction
KW - Meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85071499967&partnerID=8YFLogxK
U2 - 10.15283/ijsc18122
DO - 10.15283/ijsc18122
M3 - Review article
AN - SCOPUS:85071499967
SN - 2005-3606
VL - 12
SP - 206
EP - 217
JO - International Journal of Stem Cells
JF - International Journal of Stem Cells
IS - 2
ER -