The aim of this study was to investigate the mechanism by which a diet inducing high hyperhomocysteinemia (HHcy) leads to the deterioration of erectile function in rats and whether this is inhibited by expression of the human tissue kallikrein-1 (hKLK1) gene.We established a rat model of HHcy by feeding methionine (Met)-rich diets to male Sprague-Dawley (SD) rats.Male wild-type SD rats (WTRs) and transgenic rats harboring the hKLK1 gene (TGRs) were fed a normal diet until 10 weeks of age.Then,30 WTRs were randomly divided into three groups as follows:the control (n =10) group,the low-dose (4％ Met,n =10) group,and the high-dose (7％ Met,n =10) group.Another 10 age-matched TGRs were fed the high-dose diet and designated as the TGR+7％ Met group.After 30 days,in all four groups,erectile function was measured and penile tissues were harvested to determine oxidative stress,endothelial cell content,and penis fibrosis.Compared with the 7％ Met group,the TGR+7％ Met group showed diminished HHcy-induced erectile dysfunction (ED),indicating the improvement caused by hKLK1.Regarding corpus cavernosum endothelial cells,hKLK1 preserved endothelial cell-cell junctions and endothelial cell content,and activated protein kinase B/endothelial nitric oxide synthase (Akt/eNOS) signaling.Fibrosis assessment indicated that hKLK1 preserved normal penis structure by inhibiting apoptosis in the corpus cavernosum smooth muscle cells.Taken together,these findings showed that oxidative stress,impaired corpus cavernosum endothelial cells,and severe penis fibrosis were involved in the induction of ED by HHcy in rats,whereas hKLK1 preserved erectile function by inhibiting these pathophysiological changes.