Mechanism of Traditional Chinese medicine extract in the treatment of diabetic erectile dysfunction

Ethnopharmacological relevance: Diabetic erectile dysfunction (DED) is a prevalent but often overlooked microvascular complication of type 2 diabetes mellitus (T2DM), with strong associations to cardiovascular disease. The pathophysiology of erectile dysfunction (ED) in T2DM patients is more intricate than in non-diabetic individuals, likely involving multiple pathogenic mechanisms such as endothelial dysfunction, vascular alterations, neuropathy, and oxidative stress. Traditional Chinese Medicine (TCM) has long been utilized in the management of DED, drawing on an extensive body of clinical experience. In TCM, DED is typically attributed to imbalances such as renal yang deficiency or insufficiencies in qi and blood. Herbal therapies within the TCM framework offer a multifaceted approach to treatment, targeting not only the replenishment of kidney yang and the regulation of qi and blood but also incorporating strategies for glycemic control and renal protection. This holistic approach has demonstrated effectiveness in alleviating erectile dysfunction in diabetic patients, thereby improving quality of life. However, the complexity of Chinese herbal formulations, with their diverse bioactive constituents, complicates the identification of specific active compounds and the mechanistic understanding of their therapeutic actions. This complexity has contributed to ongoing skepticism regarding the clinical utility of TCM and herbal remedies in the treatment of DED.

Aim of the study: This study aimed to investigate the pathological mechanisms underlying the therapeutic effects of TCM in the treatment of DED, with a specific focus on the associated signaling pathways. By elucidating these mechanisms, the study seeks to provide a scientific basis for novel therapeutic strategies and enhance the viability of TCM-based approaches for DED management. Future research should prioritize the development of efficacious Chinese patent medicines tailored for the treatment of DED.

Methods: This study utilizes keywords such as "diabetic erectile dysfunction" , "signaling pathways", "traditional Chinese Medicine", "bioactive compounds", "herbal", "herbal monomers", and "herbal extracts" to conduct a comprehensive literature search in databases including Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP, spanning all relevant publications up to February 2024.

Results: It has been demonstrated that TCM extract can treat the DED by influencing the signaling pathways involved.

Conclusion: A comprehensive literature review was conducted across multiple databases, followed by rigorous screening, exclusion, summarization, synthesis, and analysis of relevant studies. The results indicate that TCM for DED primarily targets key pathological features, including endothelial dysfunction, vascular and neural abnormalities, and oxidative stress. The underlying mechanisms involve the NO/ cGMP, eNOS, and PI3K/Akt/mTOR signaling pathways, contributing to significant improvements in erectile function. These findings provide a scientific basis for the use of TCM in DED, offering viable therapeutic options and innovative strategies to advance TCM-based treatment approaches. Furthermore, TCM exhibits notable potential in mitigating the pathological progression of DED. The pharmacological mechanisms and molecular signaling pathways of TCM extracts have been extensively investigated, underscoring their high value for clinical research and therapeutic development.