POSSIBLE INFLUENCE OF Terminalia Catappa LEAVES EXTRACT ON SOME HORMONES IN RELATION TO ERECTILE DYSFUNCTION IN STREPTOZOTOCIN INDUCED WISTER RATS
CHAPTER ONE
1.1 BACKGROUND OF STUDY
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by ineffectiveness of the insulin produced, such a deficiency results in increased concentration of glucose in the blood, which in turn damages many of the body’s systems in particular the blood vessels and nerves (Lemelman et al., 2018). Diabetes is associated with sexual dysfunction both in male and female, diabetes induced sexual dysfunction in men is known as erectile dysfunction.
Erectile dysfunction (ED) is a common male sexual dysfunction in which the penis cannot achieve or maintain an adequate erectile status for sexual performance when receiving effective stimulation (Irwin et al., 2019). ED is a predominant sexual dysfunction and it is considered a key factor of functional incapability in sexual intercourse. In normal penile erection, the healthy nitrergic nerves, carvenous nerve, endothelium, smooth muscles, and cells such as cavernous neurons, endothelial cells, and corpus cavernosum smooth muscle cells (CCSMCs) all play a critical role, they are the major components that play a vital role in the process and their loss impairs erectile process (Zhou et al., 2017).
Several factors induce erectile dysfunction (Schaver et al., 2015), it has been emphasized as a common chronic complication of diabetes mellitus (Papazafiropouiou et al., 2020). Recent studies revealed that 52.5% of DM patients have ED, thus implying that more than half of DM patients have sexual complications. Recent studies have focused on multiple dimensions of DM-ED treatment to elevate the quality of life, numerous therapeutic measures for DM-ED are currently being practiced such as prosthesis, vacuum devices, surgical therapy, stem cell therapy, and the most frequently employed oral medical therapy (Zhou et al., 2017). The well-known drug phosphodiesterase-5-inhibitor is a widely used pharmacotherapy, the effectiveness of these PDE-5 inhibitors are further reduced due to the inadequate bioavailability of NO from both neuropathic and endothelial dysfunction in diabetic men. It has few side effects (for instance, headaches and gastrointestinal indisposition) and consequently limits patient compliance (Yu et al., 2019).
Diabetes affect penile erection in diabetic men due to the neuropathy of the cavernous nerve (CN), a parasympathetic nerve that innervates the penis and regulates erectile function. As the neuropathy develops phosphodiesteras-5 (PDE-5) inhibitors show limited efficacy (up to 59% ineffective) thereby not allowing maintenance of smooth muscle relaxation and erection to occur via the inhibition of PDE-5 enzymes. In DM-ED no single mechanism is responsible, multiple mechanisms act in synergy to initiate DM-ED, this leads to an irreversible damage of the carvenosum. The principal mechanism for DM-ED is smooth muscle dysfunction which is secondary to the effect of Advanced glycation end-products (AGE) on smooth muscle function Endothelial dysfunction is another potential mechanism of DM-ED. It rapidly renders the functional syncytium of the corpora-carvenosa ineffective. Therefore improving the understanding of the mechanisms underlying the development of DM-ED could lead to a continuous search for other ways of treating ED in DM (Fedele et al., 2016).
The nuts (seeds) of Terminalia Catappa possess potent aphrodisiac property, it enhances sperm production and sex drive in male animals. It can be useful in the treatment of premature ejaculation, prolongation of ejaculatory latency (Ratnasooriya et al., 2018). On this note, the leaf of Terminalia Catappa claimed to have aphrodisiac activity is being investigated. And this study seeks to know the usefulness of the leaf of Terminalia Catappa on erectile dysfunction.
1.2. AIMS OF THE STUDY
The aim of the study is to investigate the possible influence of Terminalia Catappa leaves extract on some hormones in relation to erectile dysfunction in streptozotocin induced Wister rats and to achieve this aim, the following objectives will be considered;
OBJECTIVES:
- Assessment of serum level of Nitric-oxide (NO) as an important vasodilator in diabetic and non- diabetic rats following the administration of Terminalia Catappa extract
- Determine the levels of Testosterone in diabetic rats and non- diabetic rats following the administration of Terminalia Catappa extract
- Assess the gonadotropin hormone level -Luteinizing hormone following the administration of Terminalia Catappa extract
- Assessment of the changes in these parameters following the administration of Terminalia Catappa leaf extract.
- Assessment of the effectiveness of Terminalia Catappa on DM and ED.
1.3 SCOPE OF THE STUDY
This study will encompass determination of the effects of Terminalia Catappa on diabetes mellitus associated erectile dysfunction through assessment and/or determination of some hormones level.
1.4 STATEMENT OF RESEARCH PROBLEM
Diabetes has been a prevalent disease World -wide. It has become the most common illness ranging from young to old age groups (Thorve et al., 2018). Treatment of diabetes with synthetic drugs has dangerous effects on the body because it can cause side effects in the long-run. Diabetes mellitus has led to many complications with erectile dysfunction increasing rapidly.
Erectile dysfunction (ED) has been considered the most important sexual dysfunction in men with diabetes mellitus. Until recently, erectile dysfunction was one of the most neglected complication of diabetes. Many men seeking help for their ED are unaware they have diabetes which makes treatments almost impossible, the analysis of both semen testosterone levels and hemoglobin A1c is a vital part of the clinical evaluation of diabetes which automatically provides solutions to the diabetes induced ED as diabetic men with sexual disorders have elevated glycated hemoglobin levels.
Patients with diabetic ED fails to respond to PDE-5 inhibitors because the C-GMP levels are not reaching the threshold needed to induce penile erection, this is due to insufficient nitric-oxide caused by endothelial dysfunction and neuropathy.
Although, lifestyle changes may help improve sexual function, specific treatments are often needed. ED is more severe and less responsive to oral drugs and the treatment option for ED seems quite expensive. ED is relatively common among men, yet there is paucity of information on erectile dysfunction amongst men. Since the prevalence of ED in men is considerably high, it is often undiagnosed and under managed.
1.5 SIGNIFICANCE OF THE STUDY
This research will provide data and information on substances that can ameliorate ED, help to provide cost effective alternatives and provides information on the relationship between DM and ED and also the proper management of DM and ED.
1.6 JUSTIFICATION OF THE STUDY
Erectile dysfunction (ED) is a recognized complication of diabetes mellitus, with it’s attendant negative effects on the psychosexual and overall quality of life and well being of the affected individuals. Pharmacological treatment of ED in DM is associated with some challenges and attention is directed to natural substance. The leaf and nuts of Terminalia Catappa have been reported to have aphrodisiac activity and thus has been scientifically proven on the nuts(seeds) but not on the leaves .
Therefore, the need to scientifically find out the aphrodisiac activity of the leaves of Terminalia Catappa becomes necessary
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