Neue Aspekte zur Ätiopathogenese der Induratio penis plastica

Zusammenfassung

Dieser Beitrag gibt eine Übersicht über den aktuellen Kenntnisstand zur Ätiopathogenese der Induratio penis plastica. De la Peyronie vermutete einen Zusammenhang mit venerischen Erkrankungen. Neben infektiösen werden traumatische, vor allem (auto-)immunologische und genetische Ursachen diskutiert. Eine wichtige Hypothese ist Beeinflussung durch wiederholte Mikrotraumen in der Tunica albuginea, die beim Geschlechtsverkehr zu Läsionen mit anschließender Aktivierung von Wundheilungsprozessen und Entwicklung des fibrotischen Plaques führen. Eine Assoziation mit den Antigenen des HLA-System kann nach neuesten Studien ausgeschlossen werden. Transforming Growth Factor beta (TGF-β) scheint einen entscheidenden Einfluss zu spielen, da er vermehrt im Plaque exprimiert wird und im Tiermodell durch intratunikale Injektion von Zytomodulin - einer Substanz mit TGF-β ähnlicher Aktivität - IPP-ähnliche Veränderungen erzeugt werden können. Wie bei anderen fibrotischen Erkrankungen scheint eine Verschiebung des Verhältnisses Nitridoxid (NO) zu reaktiven Sauerstoffspezies (ROS) einen Einfluss zu haben. Die wichtigsten neuen Aspekte wurden in der Untersuchung von Zellkulturmodellen gewonnen, in denen eine vermehrte Expression von Basic Fibroblast Growth Factor (bFGF), eine Änderung der Zellzyklusregulation sowie zytogenetische Instabilität beobachtet wurden.

Abstract

This paper reviews the current knowledge of the etiological pathogenesis of Peyronie's disease. De la Peyronie himself supposed a connection with venereal diseases. Herein, infectious, traumatic, autoimmune and genetic causes are discussed. An important hypothesis is that the recurrent microtraumatisation of the tunica albuginea during sexual intercourse leads to small lesions that activate processes of wound healing and development of fibrotic plaque. According to recent data, an association with the antigens of the HLA-system could be ruled out. Transforming growth factor beta (TGF-β) seems to have an important impact due to its increased expression in the plaque. Furthermore it is possible to induce a condition similar to Peyronie's disease by intratunical injection of cytomodulin - a substance with TGF-β-like activity - in an animal model. As in other fibrotic diseases, an imbalance between nitric oxide (NO) and reactive oxygen species (ROS) seems to be of importance. The most important new insights were gained from cell-culture models in which increased expression of basic fibroblast growth factor (bFGF), as well as a change in cell cycle regulation (p53) and cytogenetic instability were observed.

Induratio penis plastica - Ätiopathogenese - HLA-System - TGF-β - NO/ROS - Zellkultur - zytogenetische Instabilität

Peyronie's disease - etiological pathogenesis - HLA-system - TGF-β - NO/ROS - cell culture - cytogenetic instability

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