WP 3

Can stromal vascular fraction (SVF) stem cells be used in the treatment of erectile dysfunction (ED) in men after a prostatectomy.

Background

Prostate cancer is the most common cancer among Danish men, and the incidence is increasing. In 2011, 4,100 new cases diagnosed and 1100 was operated.

After prostatectomy, 80% experience erectile dysfunction, of which, approximately 58% have “little effect” by medical treatment e.g.5-PDE inhibitors.

The sexual life is a central part of people’s identity, self-esteem and quality of life.

There is medical treatment for erectile dysfunction, but far all patients are adequately helped and there is a need for new and better treatment. Patients who do not have the effect of medical treatment can be offered a penile prosthesis.

Stem cell therapy may be an interesting alternative for patients who do not have therapeutic effects of phosphodiesterase type 5 inhibitors such as sildenafil, tadalafil and vardenafil. The penis is a vascular body, and erection resulting from blood-filled vascular cavity in the penis, the so-called sinusoids consisting of endothelial cells surrounded by several layers of cavernous vascular smooth muscle cells. These cells relaxeres by NO, produced by muscle cells themselves and the cavernous nerve with sexual stimulation, which leads to engorgement which slowly compresses the venous outflow. Erectile dysfunction appears among others by nerve cavernosus damage caused by prostatectomy, diseases in the small vessels e.g caused by diabetes mellitus.

SVF most studies so far carried out as cultured SVF cells, however, it has been shown that non-cultured SVF cells also have a regenerative effect 1. It has been previously seen that non-cultured SVF cells maintain their stem cell potential much better, and the use of mainly derived cells will shorten the procedure substantially and minimize the risk of contamination, which also has an economic aspect.

Approach

In this study we will not use cultured stem cells. We use isolated stem cells using Cytori’s Celution. Treatment is safe with no cases of “adverse events” associated with liposuction and or stem cell injection. Other studies have not shown any serious adverse events in their follow-up period of 1 year. KBF provide treatment and the extraction of stem cells. This procedure is carried out with “Cytori Celution” which is CE approved in Europe. In this method there is no risk for the development of endotoxins or bacterial contamination, as the system is sterile and closed, and the procedure is performed in a sterile operating room. Quality control and calibration of the machine by personnel from KBF from standardized procedure description. The lipo suction is performed by the Department of Plastic surgery.

We aim to inject approximately 15 million stem cells. There are no data on the use of directly isolated stem cells. We know from the only published study with people that this amount has been proven effective. The number of stem cells will vary with the amount of fat patients have available subcutaneously in the abdomen, and we will not remove more than 360 ml subcutaneous fat because it is the upper limit amount of fat we can directly isolate. This pilot project will help to explore whether there will be a difference in the effect depending on the dose that we deal with.

Research Interest

To investigate and evaluate the SVF can be used as treatment of ED in men who have undergone prostatectomy due to prostate cancer.

The pilot study conducted as part of a PhD study. We have great expectations that stem cell therapy has a positive effect on erectile ability. Afterwards we will conduct a randomized trial to determine whether treatment with stem cells is better than other established treatment for ED.



Available positions and Contacts

We always seek ambitious students (within medical or natural sciences) with a large degree of curiosity on nature’s biology. For questions, contact Lars Lund (lars.lund@rsyd.dk; +45 20720266)

Research group

Lars Lund

Group leader
Professor
CV
Publications


+ 45 20 72 02 66
lars.lund@rsyd.dk

Søren Paludan Sheikh

Professor
CV
Publications


+ 45 21 38 04 10
soeren.sheikh@rsyd.dk

Research interest

The ability to convert any human cell to other specialised cell types of the body will allow the regeneration of tissues and organs as well as develop personalised therapies. It is now possible to reprogram biopsied human cells to become induced pluripotent stem (iPS) cells, which are very similar to embryonic stem (ES) cells.

Lab page »

Selected publications

  1. Lund L, Kloster A, Cao T. The Long-Term Efficacy of Hydrocele Treatment with Aspiration and Sclerotherapy with aethoxysclerol compared to Placebo – a prospective double-blind randomized study. J Urol. 2013 Nov 18.
    Olsen AB, Andersen PK, Bank S, Søby KM, Lund L, Prag J Actinobaculum schaalii, a commensal of the urogenital area. BJU Int. 2013;112:394-7.
  2. Reliable and valid assessment of Lichtenstein Hernia repair skills. Carlsen CG, Lindorff-Larsen K, Funch-Jensen P, Lund L, Charles P, Konge L. Hernia. 2013 Dec 3.
  3. Hong Gao, Jes Sandermann, Jørgen Prag, Lars Lund, Jes S. Lindholt, Rifampicin-soaked silver versus polytetrafluoroethylene grafts for in situ replacement of graft infection in a porcine randomized controlled trial. Eur J Vasc Surg 2012; 43:582-7.
  4. Bank S, Hansen TM, Søby KM, Lund L, Prag J. Actinobaculum schaalii in urological patients screened with real-time Polymerase chain reaction. Scand J Infec dis 2011; 45:406-10.
  5. Borre M, Erichsen R, Lund L, Larsen EH, Nørgaard M, Jacobsen J. Continuous improved survival of prostate cancer patients in Northern Denmark, 1998-2009. Clin Epidemiol 2011;3:41-6.
  6. Lund L, Erichsen R, Larsen EH, Borre M, Jacobsen J,Nørgaard M.Survival of invasive bladder cancer patients, 1998-2009;A Danish population-based cohort study. Clin Epidemiol 2011;3:47-51.
  7. Pelant T, Larsen EH, Lund L, Borre M, Erichsen R, Nørgaard M, Jacobsen J. Limited improvement in the survival of patients with kidney cancer in Northern Denmark, 1998-2009. Clin Epidemiol 2011;3:53-8.
  8. Gao H, Sandermann J, Prag J, Lund L, Lindholt JS. Prevention of primaryvascular graft infection with silver-coated polyester graft in a porcine model. Eur J Vasc Surg 2010; 39:472-7.
  9. Lund L, Clark PE, Jacobsen J, Sørensen HT, Nørgaard M. The impact of comorbidity on survival of invasive bladder cancer patients, 1995-2004; A Danish population-based cohort study. Urology. 2010;75:393-8.
  10. Laurberg J, Nielsen J, Lund L. Nefrektomi med ethulstrcart. Ugeskr Læger 2010;172: 2147-2148.
  11. Petersen LJ, Lund L, Jønler M, Jakobsen M, Abrahamsen J. Samarium-153 for treatment of bone pain in patients with metastatic prostate cancer- results from a single Danish institution Dan Med Bull 2010; 57 A4154
  12. Lund L, Jønler M, Graversen PH, Borre M, og Bro F. ”Shared Care Model” til patienter med prostata cancer. Dan Med J. 2013 Aug; 60(8):A4691.
  13. Haahr M, Christensen M, Sheik SP, Lund L. Stamceller til behandling af erektiv dysfunktion. Ugeskr for Laeger 2014, 176(42):in print
  14. Lund L. Biopsi af små nyretumorer. Ugeskr for Laeger 2014;176:1017.
  15. Svolgaard N, Lund L. Salvagebehandling af cancer prostatae. Ugeskr for Laeger 2014;176.
  16. Mortensen MA, Engvad B, Geertsen L, Svolgaard N, Lund L. Metastase i testis fra prostatacancer. Ugeskr for læger 2014; 176: 2-3.

Funding