Effects of Stem Cell Derived Exosome Therapy on Erectile Dysfunction: A meta-analysis of preclinical studies

Background: Exosome is considered a potential cell-free therapy for treating erectile dysfunction (ED), which was investigated in some preclinical studies. The therapeutic efficacy has not been comprehensively evaluated. Aim: To further study the therapeutic effects of exosomes derived from stem cells on ED in preclinical studies and investigate some possible factors that influence treatment efficacy. Methods: The literature research was conducted in Web of Science, PubMed and Embase to retrieve studies utilizing stem cell derived exosomes to treat ED. Revman 5.3 was used to perform subgroup analysis of intracavernosal pressure/mean artery pressure (ICP/MAP) and structural changes. Publication bias was assessed with Egger's test, funnel plot, and sensitivity analysis by Stata 15.0. Outcomes The ICP/MAP and structural changes after stem cell treatment. Results: Of 146 studies retrieved, 11studies are eligible. Pooled analysis showed that stem cell derived exosomes ameliorates damaged ICP/MAP (WMD 3.68; 95% CI 2.64-4.72; P < .001) and structural changes, like the ratio of smooth muscle to collagen (SM/Collagen), alpha smooth muscle actin (α-SMA), the cluster of differentiation 31 (CD31), neuronal nitric oxide synthase (nNOS), endothelial nitric oxide synthase (eNOS), transforming growth factor-β1 (TGF-β1) and caspase-3 protein expression. Subgroup analysis indicated that exosome type and ED model type make no difference to curative effects. Conclusion: This meta-analysis suggests the efficacy of stem cell derived exosome therapy for ED and the possible mechanism in erection restoration and structure renovation.