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. 2022 Oct 27;14:1945–1961. doi: 10.2147/NSS.S375571

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© 2022 Zhang et al.

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Principal molecular mechanisms of penile erection, and possible targets by which short sleep duration impairing the erectile function.The molecular mechanisms of penile erection involve a balance of signaling between relaxation and contraction of CCSMC. Generally, the NOS-NO-cGMP signaling pathway is considered as the most important mechanism of penile erection, involving the PKG activation and decreased intracellular levels of calcium. On the contrary, penile flaccidity is mainly regulated by the NA, ET-1, and AngII signaling, involving increasing levels of intracellular calcium. Meanwhile, RhoA/ROCK signaling known as the calcium-sensitized pathway, and NA-ADRa1 signaling are crucial to regulate the chronic contraction of CCSMC. In all, ROCK deactivates the MLCP by phosphorylating MYPT1, or directly phosphorylates the MLC2, promoting the contraction of CCSMC. Additionally, the adenosine signaling pathway also has a role in the regulation of erectile function. In short, the short sleep duration might break the balance between the signaling pathways associated with penile erection and flaccidity, resulting in ED.

Abbreviations: ED: Erectile dysfunction; HPA axis: Hypothalamic-pituitary-adrenal axis; ANS: Autonomic nervous system; SREs: Sleep-related erections; NPY: Neuropeptide Y; CCSMC: Corpus cavernosum smooth muscle cell; SMCs: smooth muscle cells; nNOS, Neural nitric oxide synthase; eNOS; Endothelial nitric oxide synthase; NO, Nitric oxide; NANC fibers: non-adrenergic non-cholinergic fibers; GC: Guanylyl cyclase; PKG: Protein kinase G; cGMP: Cyclic guanosine monophosphate; PDE: phosphodiesterase; NA: Noradrenaline; ET-1: Endothelin-1; Ang II: Angiotensin II; ADRa1: adrenergic receptor α- 1; RhoA: Ras homolog gene family member A; Rho-GEF: Rho guanosine exchange factor; ROCK: Rho-associated coiled-coil containing kinase; MLC: Myosin light chain; MLCP: Myosin light-chain phosphatase; MYPT1: Myosin phosphatase target subunit 1; MLC2: myosin light-chain 2; MLCK: Myosin light-chain kinase; CaM: Calmodulin;