The Control of Corporal Smooth Muscle Tone, the Coordination of Penile Erection, and the Etiology of Erectile Dysfunction: The Devil is in the Details

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Abstract
Penile erection is a complex neurovascular event with hemodynamic features analogous to those observed in vascular tissues throughout the vascular tree. A spate of recent basic research activity into the mechanistic basis for the control of penile erection and the etiology of erectile dysfunction has highlighted the central role of the corporal smooth muscle cell in this process. It is now clear that penile erection is highly dependent not only on the integrity of the corporal smooth muscle cells that comprise the vast majority of the corporal parenchyma, but also on their ability to respond to stimuli for both contraction and relaxation in a coordinated and syncytial fashion. As such, further elaboration of the precise mechanistic details concerning the physiology and pathophysiology of the control of corporal smooth muscle tone represents the greatest remaining barrier to the improved understanding, diagnosis, and treatment of erectile dysfunction. It is anticipated that multidisciplinary basic research studies that utilize the vertical approach—that is, incorporate studies ranging from examination of the patient in the clinic, to physiological/pharmacological studies of isolated corporal tissue strips from these same patients, to biochemical and electrophysiological studies of the cells derived from tissues of these same patients, to studies of protein and gene expression in their corresponding cells—will allow the quickest transition from “the bench to the bedside.” In particular, it would appear that the success of such translational research will be closely linked to progress/developments in the field of molecular biology/genetics, and their applicability/relevance to the diagnosis and treatment of erectile dysfunction. One such application, namely genetic therapy for the treatment of erectile dysfunction, seems especially appealing and probable.