Amelioration of neurogenic erectile dysfunction by ST36 electroacupuncture

Cavernous nerve (CN) injury-induced neurogenic erectile dysfunction (ED) remains clinically intractable, mainly driven by post-injury cavernous autonomic imbalance and subsequent pathological remodeling. In a bilateral cavernous nerve injury (BCNI) rat model, we detected early sustained sympathetic hyperactivity and parasympathetic suppression in the corpus cavernosum, which significantly correlated with fibrotic progression. Electroacupuncture (EA) at Zusanli (ST36), a non-invasive neuromodulation, effectively reversed this autonomic imbalance, achieving significant erectile function recovery and attenuated penile pathological remodeling. Proteomics showed that EA-ST36 markedly upregulated cavernous L-arginine biosynthesis, with key enzyme argininosuccinate synthase 1 (ASS1) enriched in cavernous endothelial cells. α-Methyl-DL-aspartate (α-MDLA) inhibition of this pathway abolished EA's protective effects, which were rescued by arginine supplementation, confirming that EA acts via the L-arginine/nitric oxide (NO) signaling. Collectively, non-invasive ST36 EA is a promising strategy for penile rehabilitation in neurogenic ED patients.