title: PDE5A Polymorphisms Influence on Sildenafil Treatment Success.
abstract: Diabetes and cardiovascular disease are risk factors for erectile dysfunction (ED). Selective inhibitors of the type 5 phosphodiesterase are the first option for treating ED. However, it is unknown why there are patients with low response to this treatment. Polymorphisms in the PDE5A gene may influence the response to PDE5 inhibitors treatment.
  
  
  
  The aim of this study is to analyze the relationship between PDE5A polymorphisms, diabetes, and the efficacy of sildenafil treatment.
  
  
  
  A Spanish prospective cohort of 170 Caucasian male patients diagnosed with ED and ischemic heart disease treated with angioplasty was studied.
  
  
  
  ED was evaluated according to the 5-item version of the International Index for Erectile Function before and after treatment with sildenafil 50 mg. The gene sequence of the PDE5A gene was analyzed for the presence of rs12646525 and rs3806808 polymorphisms. Glucose and glycosylated hemoglobin levels were measured in blood serum samples. The relationship between treatment response, genotype, and glycemic status was analyzed.
  
  
  
  Patients with G-allele of rs3806808 polymorphism showed a worse response to the treatment compared to TT-homozygote patients. Nondiabetic G-allele carriers showed a worse treatment response than TT-homozygotes patients. These differences were not seen in diabetic patients. There were no significant differences in treatment response according to the rs12646525 polymorphism in total population or according to the glycemic status. Logistic regression analysis showed that nondiabetic carriers of the major allele of both the rs12646525 and rs3806808 polymorphism had a significantly higher likelihood to respond to the treatment than diabetic patients carriers of the minor allele (P < .05).
  
  
  
  The response to sildenafil treatment depends on polymorphisms in the PDE5A gene and the glycemic status of the patients.
authors.affiliation: Department of Urology, University Hospital Virgen de la Victoria, Campus Universitario de Teatinos s/n, Malaga, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Marchal-Escalona
authors.affiliation: Department of Urology, University Hospital Virgen de la Victoria, Campus Universitario de Teatinos s/n, Malaga, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Herrera-Imbroda
authors.affiliation: CIBER Fisiopatología de la Obesidad y Nutrición. CB06/03, Instituto de Salud Carlos III, Madrid, Spain; Unidad Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Málaga, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Clemente-Postigo
authors.affiliation: CIBER Fisiopatología de la Obesidad y Nutrición. CB06/03, Instituto de Salud Carlos III, Madrid, Spain; Unidad Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Málaga, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Alcaide-Torres
authors.affiliation: Department of Urology, University Hospital Virgen de la Victoria, Campus Universitario de Teatinos s/n, Malaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Quiñonero
authors.affiliation: Nursing Department, Hospital Parque S. Antonio, Malaga, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Marchal
authors.affiliation: CIBER Fisiopatología de la Obesidad y Nutrición. CB06/03, Instituto de Salud Carlos III, Madrid, Spain; Unidad Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Málaga, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Queipo-Ortuño
authors.affiliation: Department of Urology, University Hospital Virgen de la Victoria, Campus Universitario de Teatinos s/n, Malaga, Spain.
authors.forename: Isabel María
authors.initials: IM
authors.lastname: Aragón
authors.affiliation: Department of Urology, Hospital Regional de Málaga, Málaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Martín-Morales
authors.affiliation: Department of Urology, University Hospital Virgen de la Victoria, Campus Universitario de Teatinos s/n, Malaga, Spain. Electronic address: mf.lara@fimabis.org.
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: Lara
authors.affiliation: CIBER Fisiopatología de la Obesidad y Nutrición. CB06/03, Instituto de Salud Carlos III, Madrid, Spain; Unidad Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Málaga, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cardona
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5 / Q000187:drug effects* / Q000235:genetics*; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012307:Risk Factors; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D000068677:Sildenafil Citrate; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; C517381:PDE5A protein, human
keywords: Diabetic; Erectile dysfunction; PDE5 polymorphism; Sildenafil