Adipose Tissue-Derived Stem Cell Therapy for Cavernous Nerve Injury-Induced Erectile Dysfunction in the Rat Model: A Systematic Review and Meta-Analysis Using Methodological Quality Assessment
International Journal of Stem Cells
; : 206-217, 2019.
Article
in En
| WPRIM
| ID: wpr-764081
Responsible library:
WPRO
ABSTRACT
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 ANDRESULTS:
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.Key words
Full text:
1
Index:
WPRIM
Main subject:
Stem Cells
/
Population Characteristics
/
Bias
/
Blindness
/
Collagen
/
Treatment Outcome
/
Guanosine Monophosphate
/
Models, Animal
/
Nitric Oxide Synthase Type I
/
Arterial Pressure
Type of study:
Prognostic_studies
/
Systematic_reviews
Limits:
Animals
Language:
En
Journal:
International Journal of Stem Cells
Year:
2019
Type:
Article