Mesenchymal stem cells alone or ex vivo gene modified with endothelial nitric oxide synthase reverse age-associated erectile dysfunction. TJ Bivalacqua, W Deng, M Kendirci, MF Usta, C Robinson, BKTaylor, SNMurthy, HCChampion, WJG Hellstrom, PJ Kadowitz. Am J Physiol 2007; 292:H1278–90. Overexpression of arginase in the aged mouse penis impairs erectile function and decreases eNOS activity: Influence of in vivo gene therapy of anti-arginase. TJ Bivalacqua, AL Burnett, WJG Hellstrom, HC Champion. Am J Physiol 2007;292:H1340–51. Editorial Comment: Investigations into the molecular mechanisms responsible for ageassociated erectile dysfunction in the absence of overt disease have been undertaken only within the past decade. These two studies illustrate different, but effective, approaches in ameliorating erectile dysfunction in aged animals. In the first study, investigators isolated mesenchymal stem cells (MSCs) from bone marrow and injected them directly into the penile corpus cavernosum. Consistent with earlier studies by the same investigators, MSCs initially expressed markers for both smooth muscle (smooth muscle actin) and endothelial cells (von Willebrand factor) and survived within the corpus cavernosum for up to 21 days after injection with no signs of tissue inflammation. After 21 days,MSCs exhibited an alteration in phenotype, expressing additional proteins characteristic of smoothmuscle and endothelial cells that were not present at the time of isolation. Most importantly, aged rats injected with MSCs exhibited increases in endothelial nitric oxide synthase (eNOS) protein, enzyme activity, and cyclic guanosine monophosphate (cGMP) accumulation with enhanced erectile function at 21 days. Intracavernosal injection of modified MSCs, infected with adenovirus containing the eNOS gene, improved erectile function in aged rats as early as 7 days.While further studies are required to determine the feasibility of adult stem cell therapy in humans, these findings provide more evidence for the utility of MSCs in regenerative medicine and highlight the remarkable plasticity of stem cells and their ability to adapt to their local tissue environment. In the second study, investigators characterized changes in arginase and eNOS in aged mice. Erectile function in response to nerve stimulation or endothelium-dependent vasodilator was decreased as a function of age, whereas dietary intake of L-arginine for 2 weeks reversed this trend. Interestingly, mRNA and protein for both arginase I and eNOS were upregulated in endothelial cells isolated from penile tissue of aged mice. However, while arginase enzyme activity was also increased, NOS enzyme activity and baseline cGMP production was lower in penile tissue from aged mice. Because L-arginine serves as a common substrate for arginase and eNOS, the increased arginase activitymay decrease the available substrate pool to inhibit nitric oxide production. Indeed, cGMPproduction was increased to a greater extent in tissue extracts from aged rats when the arginase inhibitor 2(S)-amino-6-boronohexanoic acid (ABH) was included. Further, intracavernosal administration of ABH normalized or enhanced erectile responses in aged mice. Intracavernosal injection of adenovirus containing an antisense sequence for the arginase-I gene decreased arginase-I expression and increased erectile function, NOS activity, and cGMP production in aged mice 1 month after infection. While it is likely that multiple factors contribute to the decline in erectile function with age, these data demonstrate that upregulation of arginase I contributes to endothelial dysfunction in penile corpus cavernosum of aged animals. This thorough study enhances our appreciation for perturbations in arginine metabolism that are increasingly being related to different pathological processes in a wide variety of organ systems. Noel N. Kim, PhD