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  • Trouble de l’Érection
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Apomorphine, systèmes dopaminergiques centraux et contrôle de l’érection

Apomorphine, central dopaminergic pathways and control of penile erection

Andrologie volume 12, pages 156–166 (2002)Cite this article

Résumé

L’érection est un mécanisme vasculotissulaire provoqué par la relaxation des fibres musculaires lisses du pénis et des artères qui l’irriguent. L’érection est contrôlée par le système nerveux autonome, les voies parasympathiques étant proérectiles et les voies sympathiques antiérectiles.

Au cours des dernières années, les nombreuses données fondamentales élucidant les mécanismes locaux de l’érection ont permis de proposer des traitements des dysfonctions érectiles par des médicaments à action périphérique. Ces produits permettent soit de provoquer une érection, ils sont alors efficaces seuls, soit de potentialiser une érection.

Dans un environnement sexuellement stimulant, l’érection est provoquée par une modification de l’équilibre des effets antiérectiles du système sympathique et des effets proérectiles du système parasympathique. Les voies sympathiques et parasympathiques naissent de la moelle épinière. Le système nerveux central agit sur la moelle épinière pour contrôler et modifier cet équilibre sympathique-parasympathique. La dopamine est un neuromédiateur du système nerveux central agissant sur le comportement sexuel et sur les noyaux centaux contrôlant le tractus génital chez le mâle. Les taux de dopamine augmentent dans plusieurs noyaux centraux (amygdale, aire préoptique médiane) pendant l’activité sexuelle chez le rat. Les agonistes dopaminergiques à action centrale comme l’apomorphine (agoniste D1/D2) provoquent l’érection chez l’homme, le singe et le rat. Chez le rat, les effets proérectiles de l’apomorphine sont dus à sa fixation sur des récepteurs de type D2 dans le noyau paraventriculaire de l’hypothalamus (PVN), et seraient régulés par la testostérone. Des investigations cliniques récentes ont mis en avant les avantages de l’utilisation de l’apomorphine pour traiter les patients souffrant de dysfonctions érectiles. Une molécule à action centrale comme l’apomorphine pourrait réorganiser l’équilibre sympathique-parasympathique, conduisant à un recrutement adapté des voies nerveuses vers le pénis.

Abstract

Relaxation of penile erectile tissue and increased blood flow in the penile arteries are the two basic local mechanisms of erection. Relaxation is elicited by several agents released by the nerve terminals of sacral parasympathetic pathways (nitric oxide [NO] and vasoactive intestinal polypeptide [VIP]) and endothelial cells. The increased activity of sacral parasympathetic pathways leads to erection. Other molecules (e.g. noradrenaline) released by the nerve endings of sympathetic pathways contract the penile tissue and arteries. A decrease in sympathetic pathway activity can therefore lead to erection. A better understanding of the local mechanisms of penile erection has led to the production of compounds designed to treat erectile dysfunction via a peripheral target. Such compounds are recognised as initiators if they elicit erectionper se or as conditioners if they potentiate a mechanism already present.

The central control of penile erection plays an important role in the optimal functioning of the erectile process. Sympathetic and parasympathetic nerves to the penis originate in the spinal cord. In a sexually relevant context, it is likely that a shift of the balance between sympathetic and parasympathetic activities causes erection. This shift is controlled at the spinal cord level by information from the periphery (reflex pathways) and from supraspinal nuclei. Recent experiments have focused on supraspinal nuclei present in the brainstem, pons, and hypothalamus that directly project onto the sacral spinal cord. Pharmacological approaches have revealed an important role for central dopamine in the control of sexual behavior and the genital tract in males. Central dopamine can therefore regulate both sympathetic and parasympathetic pathways. Levels of DA and its metabolites increase in several brain structures during sexual activity. DA agonists, e.g. the D1/D2 agonist apomorphine, affect the sexual behavior, erection and ejaculation in a variety of animal species and in humans. Recent clinical investigations have revealed the benefits of the use of apomorphine in patients suffering from erectile dysfunction. Compounds acting centrally, such as apomorphine, can contribute to reorganize the activity of sympathetic and parasympathetic outflows leading to an appropriate recruitment of the autonomic pathways to the genital tract.

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    Olivier Rampin

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Rampin, O. Apomorphine, systèmes dopaminergiques centraux et contrôle de l’érection. Androl. 12, 156–166 (2002). https://doi.org/10.1007/BF03034962

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