Assessment of possible protective effects of quercetin onischemic reperfusion injury in an acute ischemic priapism model

Introduction: Priapism definition is partial or complete erection which lasts around four or more hours without sexual desire, orgasm or sexual stimuli. In ischemic priapism, there is none or few blood flow, which results progressive hypoxia, hypercarbia and acidosis. If priapism is not treated or treatment is postponed like 24 hours or more, smooth muscle necrosis, irreversible corporal fibrosis, erectile dysfunction occur. Reperfusion which occurs with termination of priapism, is needed for protecting the ischemic tissue although reperfusion itself initiates a pathophysiological process that leads to ischemia-reperfusion (I/R) injury. With I/R injury free oxygen radicals, hydroxyl radicals (OH-), Nitric Oxide (NO), peroxide radicals (ROO) and non-radical hydrogen peroxide develop. These radicals damage the cell membrane especially the membrane lipids. Quercetin which is effective against ischemia-reperfusion (I/R) injury, is a flavonoid and also an exogenous antioxidant. Quercetin has some effect on various cancer, diabet and allergic disease but being antioxidant is its best known feature. It is found in many fruits, vegetables, leaves, seeds, tea, coffee. Aim: In our study, we formed a hypothesis which say Quercetin can be beneficial to ischemia reperfusion injury in acute priapism. We assessed histologically and biochemically Quercetin's possible positive effects against ischemia reperfusion injury in a model of induced priapisim in rats. Materials and Methots: Twenty-four male Sprague-Dawley type, 350-400 gr weight rats were divided after randomization into four groups which all group has six rat, group 1 (Control), group 2 (Priapism/Reperfusion), group 3 (Priapism/Reperfusion + Dimethyl sulfoxide) and group 4 (Priapism/Reperfusion + Quercetin). Ischemic priapism model was induced by pine tipped injector vacuum erection device, based on Şanlı model. Priapism was induced in all three groups except control group. After 2h, priapism was concluded and 30 min reperfusion was performed. Then penectomy was performed in all groups. In group 3, DMSO (dimethyl sulfoxide) was administered intraperitoneally 30 min before reperfusion, while in group 4, 20mg/kg (0.5 cc) Quercetin was administered intraperitoneally 30 min before reperfusion. 3 ml blood specimens were collected from abdominal aorta in order to determine serum and tissue MDA, 4-HNE, GSH, 8-OhdG, MPO, IMA, TAS, TOS and OSI values, and penile tissue was taken for histopathological examination (urethral epithelium degeneration, muscular apoptosis index, connective tissue apoptosis index, urethral epithelium apoptosis index, sinusoidal space,tears in tunica albuginea). Results: In our study, no statistically significant difference was found in terms of histological data. A statistically significant difference was found in biochemical data in tissue MDA and Serum 4-HNE, serum IMA, tissue TAS, tissue TOS, tissue MPO and serum MPO, tissue OSI, tissue 8-OHdG levels (p<0,05). These findings show the antioxidant properties of quercetin. The absence of a significant difference in tissue 4-HNE and tissue GSH levels can be explained due to the acute period of the study model (p>0,05). Serum TAS and serum TOS, serum OSI, serum 8-OHdG, serum MDA, serum GSH levels could not be found to be statistically significant and can be explained by the short 30-minute reperfusion period used in the study for a systemic effect (p>0,05). Conclusions: In the priapism model, the result obtained by the application of quercetin before reperfusion was found compatible with the results of the experimental studies conducted in the literature. Biochemical parameters showed Quercetin's antioxidant feature. It was thought that the parameters that were not significant were related to the fact that the study was acute and the reperfusion time was short. The absence of histological changes is consistent with the finding that histological changes do not occur in priapism models shorter than 4 hours in the literature. Key Words: Acute ischemia priapism, Ischemia reperfusion injury, Quercetin