Combination of BAY 60-4552 and vardenafil exerts proerectile facilitator effects in rats with cavernous nerve injury: a proof of concept study for the treatment of phosphodiesterase type 5 inhibitor failure.

Abstract Background Radical prostatectomy (RP) is frequently responsible for erectile dysfunction (ED). Post-RP patients often show a failure to respond to phosphodiesterase type 5 (PDE5) inhibitors. Objective The acute effect of BAY 60-4552, the soluble guanylate cyclase (sGC) stimulator, and vardenafil were evaluated alone or in combination on erectile responses to electrical stimulation of the cavernous nerve (ES CN) in rats with cavernous nerve (CN) crush injury–induced ED. Design, setting, and participants Male adult Sprague-Dawley rats underwent laparotomy (sham, n =10) or bilateral CN crush injury ( n =56). After 3 wk of recovery, erectile function was evaluated under urethane anaesthesia following ES CN at different frequencies. Measurements The acute effects of intravenous (IV) injection of vehicle, vardenafil 0.03mg/kg, BAY 60-4552 0.03mg/kg or 0.3mg/kg, or a BAY 60-4552 0.03mg/kg plus vardenafil 0.03mg/kg combination were evaluated in CN-crushed rats. Results and limitations Bilateral CN crush injury followed by a 3-wk recovery period decreased erectile responses to ES CN by about 50%. In CN-crushed rats, IV vardenafil 0.03mg/kg and BAY 60-4552 (0.03 or 0.3mg/kg) increased erectile responses to ES CN to the same extent: Δ intracavernosal pressure/mean arterial pressure (ICP/MAP) at 10Hz ES CN was 21±1% after vehicle, 25±3% ( p p p Δ ICP/MAP at 10Hz ES CN: 34±4% after BAY 60-4552/vardenafil combination vs 39±4% in sham rats; not significant). Conclusions The present study supports the concept that the combined administration of a sGC stimulator, BAY 60-4552, and vardenafil provides synergistic beneficial effects and might therefore salvage patients who experience treatment failures with PDE5 inhibitors after RP.