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There are other ways smooth muscle cells in the penis can relax, resulting in an erection: During sexual arousal penile nerves release nitric oxide (NO), which activates the smooth muscle cells to release the messenger cyclic guanosine monophosphate (cGMP) inside the cells.
LINZESS binds to the GC-C receptor locally in the intestine, with no measurable blood plasma concentrations, resulting in an increase in both intracellular and extracellular concentrations of cyclic guanosine monophosphate (cGMP).
All available PDE-5 inhibitors work by inhibiting the degradation of cyclic guanosine monophosphate.
Phosphodiesterase-5 degrades cyclic guanosine monophosphate, a compound that causes vascular smooth-muscle relaxation.
It then diffuses to the vascular smooth-muscle cells and stimulates guanylate cyclase to catalyze the production of cyclic guanosine monophosphate (cGMP)--a potent vascular smooth-muscle relaxing agent--resulting in vasodilation and increased blood flow.
Other authors propose that the defect in malakoplakia may be due to low levels of cyclic guanosine monophosphate in mononuclear cells, resulting in deficient lysosomal bacterial degradation and the inability of cells to release the lysosomal enzymes.

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