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Acute radiation impacts contractility of guinea-pig bladder strips affecting mucosal-detrusor interactions. PLoS One 2018. [PMID: 29513744 PMCID: PMC5841802 DOI: 10.1371/journal.pone.0193923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Radiation-induced bladder toxicity is associated with radiation therapy for pelvic malignancies, arising from unavoidable irradiation of neighbouring normal bladder tissue. This study aimed to investigate the acute impact of ionizing radiation on the contractility of bladder strips and identify the radiation-sensitivity of the mucosa vs the detrusor. Guinea-pig bladder strips (intact or mucosa-free) received ex vivo sham or 20Gy irradiation and were studied with in vitro myography, electrical field stimulation and Ca2+-fluorescence imaging. Frequency-dependent, neurogenic contractions in intact strips were reduced by irradiation across the force-frequency graph. The radiation-difference persisted in atropine (1μM); subsequent addition of PPADs (100μM) blocked the radiation effect at higher stimulation frequencies and decreased the force-frequency plot. Conversely, neurogenic contractions in mucosa-free strips were radiation-insensitive. Radiation did not affect agonist-evoked contractions (1μM carbachol, 5mM ATP) in intact or mucosa-free strips. Interestingly, agonist-evoked contractions were larger in irradiated mucosa-free strips vs irradiated intact strips suggesting that radiation may have unmasked an inhibitory mucosal element. Spontaneous activity was larger in control intact vs mucosa-free preparations; this difference was absent in irradiated strips. Spontaneous Ca2+-transients in smooth muscle cells within tissue preparations were reduced by radiation. Radiation affected neurogenic and agonist-evoked bladder contractions and also reduced Ca2+-signalling events in smooth muscle cells when the mucosal layer was present. Radiation eliminated a positive modulatory effect on spontaneous activity by the mucosa layer. Overall, the findings suggest that radiation impairs contractility via mucosal regulatory mechanisms independent of the development of radiation cystitis.
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Smolar J, Horst M, Sulser T, Eberli D. Bladder regeneration through stem cell therapy. Expert Opin Biol Ther 2018; 18:525-544. [DOI: 10.1080/14712598.2018.1439013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jakub Smolar
- Department of Urology, University Hospital Zurich, Schlieren, Switzerland
| | - Maya Horst
- Department of Urology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Tulio Sulser
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
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Urine: Waste product or biologically active tissue? Neurourol Urodyn 2018; 37:1162-1168. [PMID: 29464759 DOI: 10.1002/nau.23414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/18/2017] [Indexed: 01/01/2023]
Abstract
AIMS Historically, urine has been viewed primarily as a waste product with little biological role in the overall health of an individual. Increasingly, data suggest that urine plays a role in human health beyond waste excretion. For example, urine might act as an irritant and contribute to symptoms through interaction with-and potential compromise of-the urothelium. METHODS To explore the concept that urine may be a vehicle for agents with potential or occult bioactivity and to discuss existing evidence and novel research questions that may yield insight into such a role, the National Institute of Diabetes and Digestive and Kidney Disease invited experts in the fields of comparative evolutionary physiology, basic science, nephrology, urology, pediatrics, metabolomics, and proteomics (among others) to a Urinology Think Tank meeting on February 9, 2015. RESULTS This report reflects ideas that evolved from this meeting and current literature, including the concept of urine quality, the biological, chemical, and physical characteristics of urine, including the microbiota, cells, exosomes, pH, metabolites, proteins, and specific gravity (among others). Additionally, the manuscript presents speculative, and hopefully testable, ideas about the functional roles of urine constituents in health and disease. CONCLUSION Moving forward, there are several questions that need further understanding and pursuit. There were suggestions to consider actively using various animal models and their biological specimens to elaborate on basic mechanistic information regarding human bladder dysfunction.
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Comparative immunohistochemical characterization of interstitial cells in the urinary bladder of human, guinea pig and pig. Histochem Cell Biol 2018; 149:491-501. [DOI: 10.1007/s00418-018-1655-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 01/20/2023]
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Jakobsen LK, Trelborg KF, Kingo PS, Hoyer S, Andersson KE, Djurhuus JC, Norregaard R, Olsen LH. Aquaporin expression in the fetal porcine urinary tract changes during gestation. Physiol Res 2018; 67:283-292. [PMID: 29303600 DOI: 10.33549/physiolres.933545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The expression of aquaporins (AQPs) in the fetal porcine urinary tract and its relation to gestational age has not been established. Tissue samples from the renal pelvis, ureter, bladder and urethra were obtained from porcine fetuses. Samples were examined by RT-PCR (AQPs 1-11), QPCR (AQPs positive on RT-PCR), and immunohistochemistry. Bladder samples were additionally examined by Western blotting. RNA was extracted from 76 tissue samples obtained from 19 fetuses. Gestational age was 60 (n=11) or 100 days (n=8). PCR showed that AQP1, 3, 9 and 11 mRNA was expressed in all locations. The expression of AQP3 increased significantly at all four locations with gestational age, whereas AQP11 significantly decreased. AQP1 expression increased in the ureter, bladder and urethra. AQP9 mRNA expression increased in the urethra and bladder, but decreased in the ureter. AQP5 was expressed only in the urethra. Immunohistochemistry showed AQP1 staining in sub-urothelial vessels at all locations. Western blotting analysis confirmed increased AQP1 protein levels in bladder samples during gestation. Expression levels of AQP1, 3, 5, 9 and 11 in the urinary tract change during gestation, and further studies are needed to provide insights into normal and pathophysiological water handling mechanisms in the fetus.
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Affiliation(s)
- L K Jakobsen
- Department of Clinical Medicine, Department of Urology, Aarhus University, Aarhus N, Denmark.
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56
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Heppner TJ, Hennig GW, Nelson MT, Vizzard MA. Rhythmic Calcium Events in the Lamina Propria Network of the Urinary Bladder of Rat Pups. Front Syst Neurosci 2017; 11:87. [PMID: 29321730 PMCID: PMC5732214 DOI: 10.3389/fnsys.2017.00087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 01/23/2023] Open
Abstract
The lamina propria contains a dense network of cells, including interstitial cells (ICs), that may play a role in bladder function by modulating communication between urothelium, nerve fibers and smooth muscle or acting as pacemakers. Transient receptor potential vanilloid 4 (TRPV4) channels allow cation influx and may be involved in sensing stretch or chemical irritation in urinary bladder. Urothelium was removed from rats (P0-Adult), cut into strips, and loaded with a Ca2+ fluorescent dye (Fluo-2 AM leak resistant or Cal 520) for 90 min (35-37°C) to measure Ca2+ events. Ca2+ events were recorded for a period of 60 seconds (s) in control and after drug treatment. A heterogeneous network of cells was identified at the interface of the urothelium and lamina propria of postnatal rat pups, aged ≤ postnatal (P) day 21, with diverse morphology (round, fusiform, stellate with numerous projections) and expressing platelet-derived growth factor receptor alpha (PDGFRα)- and TRPV4-immunoreactivity (IR). Ca2+ transients occurred at a slow frequency with an average interval of 30 ± 8.6 s. Waveform analyses of Ca2+ transients in cells in the lamina propria network revealed long duration Ca2+ events with slow upstrokes. We observed slow propagating waves of activity in the lamina propria network that displayed varying degrees of coupling. Application of the TRPV4 agonist, GSK1016790 (100 nM), increased the duration of Ca2+ events, the number of cells with Ca2+ events and the integrated Ca2+ activity corresponding to propagation of activity among cells in the lamina propria network. However, GSK2193874 (1 μM), a potent antagonist of TRPV4 channels, was without effect. ATP (1 μM) perfusion increased the number of cells in the lamina propria exhibiting Ca2+ events and produced tightly coupled network activity. These findings indicate that ATP and TRPV4 can activate cells in the laminar propria network, leading to the appearance of organized propagating wavefronts.
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Affiliation(s)
- Thomas J Heppner
- Department of Pharmacology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, United States
| | - Grant W Hennig
- Department of Pharmacology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, United States
| | - Mark T Nelson
- Department of Pharmacology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, United States
| | - Margaret A Vizzard
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, United States
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Girard BM, Tooke K, Vizzard MA. PACAP/Receptor System in Urinary Bladder Dysfunction and Pelvic Pain Following Urinary Bladder Inflammation or Stress. Front Syst Neurosci 2017; 11:90. [PMID: 29255407 PMCID: PMC5722809 DOI: 10.3389/fnsys.2017.00090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022] Open
Abstract
Complex organization of CNS and PNS pathways is necessary for the coordinated and reciprocal functions of the urinary bladder, urethra and urethral sphincters. Injury, inflammation, psychogenic stress or diseases that affect these nerve pathways and target organs can produce lower urinary tract (LUT) dysfunction. Numerous neuropeptide/receptor systems are expressed in the neural pathways of the LUT and non-neural components of the LUT (e.g., urothelium) also express peptides. One such neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP; Adcyap1) and its cognate receptor, PAC1 (Adcyap1r1), have tissue-specific distributions in the LUT. Mice with a genetic deletion of PACAP exhibit bladder dysfunction and altered somatic sensation. PACAP and associated receptors are expressed in the LUT and exhibit neuroplastic changes with neural injury, inflammation, and diseases of the LUT as well as psychogenic stress. Blockade of the PACAP/PAC1 receptor system reduces voiding frequency in preclinical animal models and transgenic mouse models that mirror some clinical symptoms of bladder dysfunction. A change in the balance of the expression and resulting function of the PACAP/receptor system in CNS and PNS bladder reflex pathways may underlie LUT dysfunction including symptoms of urinary urgency, increased voiding frequency, and visceral pain. The PACAP/receptor system in micturition pathways may represent a potential target for therapeutic intervention to reduce LUT dysfunction.
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Affiliation(s)
- Beatrice M Girard
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Katharine Tooke
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Margaret A Vizzard
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, United States
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58
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Zupančič D, Mrak Poljšak K, Kreft ME. Co-culturing porcine normal urothelial cells, urinary bladder fibroblasts and smooth muscle cells for tissue engineering research. Cell Biol Int 2017; 42:411-424. [PMID: 29115705 DOI: 10.1002/cbin.10910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/05/2017] [Indexed: 12/27/2022]
Abstract
New strategies for culturing and co-culturing of the main types of urinary bladder cells are essential for successful establishment of biomimetic in vitro models, which could be applied for research into, and management of, diverse urological disorders. Porcine normal urothelial cells are available in nearly unlimited amounts and have many properties equivalent to human urothelial cells. In the present study, we established normal differentiated porcine urothelial cells in co-cultures with porcine urinary bladder normal fibroblasts and/or smooth muscle cells. The optimal culture medium for establishment of differentiated urothelial cells, demonstrated by positive immunofluorescence of uroplakins, cytokeratins (CK 7, CK 20), zonula occludens 1 (ZO-1), claudin 4, claudin 8, and E-cadherin, was the medium composed of equal parts of Advanced Dulbecco's modified Eagle's medium (A-DMEM) and MCDB 153 medium with physiological calcium concentration of 2.5 mM and without fetal bovine serum, named UroM (+Ca2+ - S). This medium was also proven to be suitable for culturing of bladder fibroblasts and smooth muscle cells and co-culturing of urothelial cells with these mesenchymal cells. Urothelial cell differentiation was optimal in UroM (+Ca2+ - S) medium in all co-culture conditions and when compared to all conditioned-media combinations. To summarize, these strategies for culturing and co-culturing of urinary bladder urothelial cells with mesenchymal cells could be used as new in vitro models for future basic and applicable research of the urinary bladder and thus potentially also for translational tissue engineering studies.
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Affiliation(s)
- Daša Zupančič
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Katjuša Mrak Poljšak
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Mateja Erdani Kreft
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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59
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Computer-assisted three-dimensional tracking of sensory innervation in the murine bladder mucosa with two-photon microscopy. J Chem Neuroanat 2017; 85:43-49. [DOI: 10.1016/j.jchemneu.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 01/11/2023]
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60
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Lee K, Isogai A, Antoh M, Kajioka S, Eto M, Hashitani H. Role of K + channels in regulating spontaneous activity in the muscularis mucosae of guinea pig bladder. Eur J Pharmacol 2017; 818:30-37. [PMID: 29050967 DOI: 10.1016/j.ejphar.2017.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022]
Abstract
To explore the roles of various K+ channels in regulating the spontaneous activity of bladder muscularis mucosae (MM) that is considered to play an important role in maintaining mucosal function. Effects of K+ channel modulators on electrical and contractile activity in the guinea-pig bladder MM were examined using intracellular microelectrode and isometric tension recording. The MM predominately generated bursting spontaneous action potentials (SAPs) and phasic contractions (SPCs) that were blocked by nifedipine (1µM). NS309 (10µM), a small-conductance Ca2+-activated K+ (SK) channel opener, dramatically prolonged after-hyperpolarisation (AHP) and converted bursting SAPs into individually action potentials in an apamin (100nM)-sensitive manner. Apamin alone increased the number of SAPs during bursts. NS1619 (10µM), a large-conductance Ca2+-activated K+ (BK) channel opener, abolished SAPs in a manner reversed by iberiotoxin (IbTX, 100nM), a BK channel blocker. IbTX alone enlarged SAPs and abolished their AHPs. Flupirtine (10µM), a voltage-dependent K+ channel (Kv7) opener, diminished SAPs in a manner reversed by XE991 (10µM), a Kv7 channel blocker. XE991 alone exerted modest excitatory effects on SAPs. These K+ channel modulators had corresponding effects on SPCs. Bursting SAP firing appears to result from a lower level activation of SK channels in MM than that DSM. BK channels play a predominant role in regulating SAP configuration, while Kv7 channels have only a marginal role. The prevention of bursting SAPs and associated reduction in SPCs upon the pharmacological activation of a reserved population of SK channels may well have a considerable therapeutic potential.
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Affiliation(s)
- Ken Lee
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan; Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Ayu Isogai
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Minori Antoh
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Shunichi Kajioka
- Department of Applied Urology and Molecular Medicine, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hikaru Hashitani
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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61
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Cheng F, Birder LA, Kullmann FA, Hornsby J, Watton PN, Watkins S, Thompson M, Robertson AM. Layer-dependent role of collagen recruitment during loading of the rat bladder wall. Biomech Model Mechanobiol 2017; 17:403-417. [PMID: 29039043 DOI: 10.1007/s10237-017-0968-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
In this work, we re-evaluated long-standing conjectures as to the source of the exceptionally large compliance of the bladder wall. Whereas these conjectures were based on indirect measures of loading mechanisms, in this work we take advantage of advances in bioimaging to directly assess collagen fibers and wall architecture during biaxial loading. A custom biaxial mechanical testing system compatible with multiphoton microscopy was used to directly measure the layer-dependent collagen fiber recruitment in bladder tissue from 9 male Fischer rats (4 adult and 5 aged). As for other soft tissues, the bladder loading curve was exponential in shape and could be divided into toe, transition and high stress regimes. The relationship between collagen recruitment and loading curves was evaluated in the context of the inner (lamina propria) and outer (detrusor smooth muscle) layers. The large extensibility of the bladder was found to be possible due to folds in the wall (rugae) that provide a mechanism for low resistance flattening without any discernible recruitment of collagen fibers throughout the toe regime. For more extensible bladders, as the loading extended into the transition regime, a gradual coordinated recruitment of collagen fibers between the lamina propria layer and detrusor smooth muscle layer was found. A second important finding was that wall extensibility could be lost by premature recruitment of collagen in the outer wall that cut short the toe region. This change was correlated with age. This work provides, for the first time, a mechanistic understanding of the role of collagen recruitment in determining bladder extensibility and capacitance.
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Affiliation(s)
- Fangzhou Cheng
- Department of Mechanical Engineering & Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lori A Birder
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - F Aura Kullmann
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jack Hornsby
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Paul N Watton
- Department of Mechanical Engineering & Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Computer Science & INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Simon Watkins
- Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Thompson
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Anne M Robertson
- Department of Mechanical Engineering & Materials Science, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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62
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Koh SD, Lee H, Ward SM, Sanders KM. The Mystery of the Interstitial Cells in the Urinary Bladder. Annu Rev Pharmacol Toxicol 2017; 58:603-623. [PMID: 28992432 DOI: 10.1146/annurev-pharmtox-010617-052615] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intrinsic mechanisms to restrain smooth muscle excitability are present in the bladder, and premature contractions during filling indicate a pathological phenotype. Some investigators have proposed that c-Kit+ interstitial cells (ICs) are pacemakers and intermediaries in efferent and afferent neural activity, but recent findings suggest these cells have been misidentified and their functions have been misinterpreted. Cells reported to be c-Kit+ cells colabel with vimentin antibodies, but vimentin is not a specific marker for c-Kit+ cells. A recent report shows that c-Kit+ cells in several species coexpress mast cell tryptase, suggesting that they are likely to be mast cells. In fact, most bladder ICs labeled with vimentin antibodies coexpress platelet-derived growth factor receptor α (PDGFRα). Rather than an excitatory phenotype, PDGFRα+ cells convey inhibitory regulation in the detrusor, and inhibitory mechanisms are activated by purines and stretch. PDGFRα+ cells restrain premature development of contractions during bladder filling, and overactive behavior develops when the inhibitory pathways in these cells are blocked. PDGFRα+ cells are also a prominent cell type in the submucosa and lamina propria, but little is known about their function in these locations. Effective pharmacological manipulation of bladder ICs depends on proper identification and further study of the pathways in these cells that affect bladder functions.
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Affiliation(s)
- Sang Don Koh
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada 89557, USA;
| | - Haeyeong Lee
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada 89557, USA;
| | - Sean M Ward
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada 89557, USA;
| | - Kenton M Sanders
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada 89557, USA;
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63
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Comparative study of the organisation and phenotypes of bladder interstitial cells in human, mouse and rat. Cell Tissue Res 2017; 370:403-416. [PMID: 28963588 DOI: 10.1007/s00441-017-2694-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022]
Abstract
With most research on interstitial cells (IC) in the bladder being conducted on animal models, it remains unclear whether all structural and functional data on IC from animal models can be translated to the human context. This prompted us to compare the structural and immunohistochemical properties of IC in bladders from mouse, rat and human. Tissue samples were obtained from the bladder dome and subsequently processed for immunohistochemistry and electron microscopy. The ultrastructural properties of IC were compared by means of electron microscopy and IC were additionally characterized with single/double immunohistochemistry/immunofluorescence. Our results reveal a similar organization of the IC network in the upper lamina propria (ULP), the deep lamina propria (DLP) and the detrusor muscle in human, rat and mouse bladders. Furthermore, despite several similarities in IC phenotypes, we also found several obvious inter-species differences in IC, especially in the ULP. Most remarkably in this respect, ULP IC in human bladder predominantly displayed a myoid phenotype with abundant presence of contractile micro-filaments, while those in rat and mouse bladders showed a fibroblast phenotype. In conclusion, the organization of ULP IC, DLP IC and detrusor IC is comparable in human, rat and mouse bladders, although several obvious inter-species differences in IC phenotypes were found. The present data show that translating research data on IC in laboratory animals to the human setting should be carried out with caution.
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64
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Traini C, Fausssone-Pellegrini MS, Guasti D, Del Popolo G, Frizzi J, Serni S, Vannucchi MG. Adaptive changes of telocytes in the urinary bladder of patients affected by neurogenic detrusor overactivity. J Cell Mol Med 2017; 22:195-206. [PMID: 28782880 PMCID: PMC5742717 DOI: 10.1111/jcmm.13308] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/14/2017] [Indexed: 01/29/2023] Open
Abstract
Urinary bladder activity involves central and autonomic nervous systems and bladder wall. Studies on the pathogenesis of voiding disorders such as the neurogenic detrusor overactivity (NDO) due to suprasacral spinal cord lesions have emphasized the importance of an abnormal handling of the afferent signals from urothelium and lamina propria (LP). In the LP (and detrusor), three types of telocytes (TC) are present and form a 3D-network. TC are stromal cells able to form the scaffold that contains and organizes the connective components, to serve as guide for tissue (re)-modelling, to produce trophic and/or regulatory molecules, to share privileged contacts with the immune cells. Specimens of full thickness bladder wall from NDO patients were collected with the aim to investigate possible changes of the three TC types using histology, immunohistochemistry and transmission electron microscopy. The results show that NDO causes several morphological TC changes without cell loss or network interruption. With the exception of those underlying the urothelium, all the TC display signs of activation (increase in Caveolin1 and caveolae, αSMA and thin filaments, Calreticulin and amount of cisternae of the rough endoplasmic reticulum, CD34, euchromatic nuclei and large nucleoli). In all the specimens, a cell infiltrate, mainly consisting in plasma cells located in the vicinity or taking contacts with the TC, is present. In conclusion, our findings show that NDO causes significant changes of all the TC. Notably, these changes can be interpreted as TC adaptability to the pathological condition likely preserving each of their peculiar functions.
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Affiliation(s)
- Chiara Traini
- Histology and Embryology Research Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniele Guasti
- Histology and Embryology Research Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Jacopo Frizzi
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Maria-Giuliana Vannucchi
- Histology and Embryology Research Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Miyazato M, Kadekawa K, Kitta T, Wada N, Shimizu N, de Groat WC, Birder LA, Kanai AJ, Saito S, Yoshimura N. New Frontiers of Basic Science Research in Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:491-505. [PMID: 28716328 PMCID: PMC5647782 DOI: 10.1016/j.ucl.2017.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan; Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Katsumi Kadekawa
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Takeya Kitta
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Nobutaka Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - William C de Groat
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA; Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA.
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Proliferation of Interstitial Cells in the Cyclophosphamide-Induced Cystitis and the Preventive Effect of Imatinib. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3457093. [PMID: 28698872 PMCID: PMC5494099 DOI: 10.1155/2017/3457093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/21/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
Abstract
Cyclophosphamide- (CYP-) induced cystitis in the rat is a well-known model of bladder inflammation that leads to an overactive bladder, a process that appears to involve enhanced nitric oxide (NO) production. We investigated the changes in the number and distribution of interstitial cells (ICs) and in the expression of endothelial NO synthase (eNOS) in the bladder and urethra of rats subjected to either intermediate or chronic CYP treatment. Pronounced hyperplasia and hypertrophy of ICs were evident within the lamina propria and in the muscle layer. IC immunolabeling with CD34, PDGFRα, and vimentin was enhanced, as reflected by higher colocalization indexes of the distinct pairs of markers. Moreover, de novo expression of eNOS was evident in vimentin and CD34 positive ICs. Pretreatment with the receptor tyrosine kinase inhibitor Imatinib prevented eNOS expression and ICs proliferation, as well as the increased voiding frequency and urinary tract weight provoked by CYP. As similar results were obtained in the urethra, urethritis may contribute to the uropathology of CYP-induced cystitis.
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67
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McCloskey KD, Vahabi B, Fry CH. Is electrolyte transfer across the urothelium important?: ICI-RS 2015. Neurourol Urodyn 2017; 36:863-868. [PMID: 28444701 DOI: 10.1002/nau.23085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022]
Abstract
AIMS This article summarizes discussion at the International Consultation on Incontinence Research Society (ICI-RS) 2015 meeting of urine modification in the urinary tract by the urothelium. It considers the literature and proposes pertinent questions that need to be addressed to understand this phenomenon within a physiological context. METHODS Following the ICI-RS meeting, publications in PubMed relating to urine modification in the renal pelvis, ureter, and bladder were reviewed. RESULTS Historically, the urothelium has been simply considered as a passive, impermeable barrier, preventing contact between urine and the underlying cells. In addition to the ability of the umbrella cells to modify the surface area of the urothelium during bladder filling, the urothelium may also be involved in modifying urine composition. Several lines of evidence support the hypothesis that electrolytes and water can be reabsorbed by the urothelium and that this may have physiological relevance. Firstly, urothelial cells express several types of aquaporins and ion channels; the membrane expression of which is modulated by the extracellular concentration of ions including Na+ . Secondly, studies of urine composition in the renal pelvis and bladder demonstrate urine modification, indicating that water and/or electrolyte transport has occurred. Thirdly, hibernating mammals, with urothelial and bladder wall histology similar to non-hibernating mammals are known to produce and reabsorb urine daily, during long periods of hibernation. CONCLUSIONS The phenomenon of urine modification by the urothelium may be physiologically important during normal bladder filling. Research should be focused on investigating how this may change in conditions of urinary dysfunction.
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Affiliation(s)
- Karen D McCloskey
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Bahareh Vahabi
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
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68
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Patnaik SS, Laganà AS, Vitale SG, Butticè S, Noventa M, Gizzo S, Valenti G, Rapisarda AMC, La Rosa VL, Magno C, Triolo O, Dandolu V. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome. Arch Gynecol Obstet 2017; 295:1341-1359. [DOI: 10.1007/s00404-017-4364-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
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69
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Tokhmafshan F, Brophy PD, Gbadegesin RA, Gupta IR. Vesicoureteral reflux and the extracellular matrix connection. Pediatr Nephrol 2017; 32:565-576. [PMID: 27139901 PMCID: PMC5376290 DOI: 10.1007/s00467-016-3386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/24/2022]
Abstract
Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.
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Affiliation(s)
| | - Patrick D. Brophy
- Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA,Center for Human Genetics, Duke University Medical Center, Durham, NC 27710, USA
| | - Indra R. Gupta
- Department of Human Genetics, McGill University, Montreal, QC, Canada,Department of Pediatrics, McGill University, Montreal, QC, Canada
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70
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Neuhaus J, Schröppel B, Dass M, Zimmermann H, Wolburg H, Fallier‐Becker P, Gevaert T, Burkhardt CJ, Do HM, Stolzenburg J. 3D‐electron microscopic characterization of interstitial cells in the human bladder upper lamina propria. Neurourol Urodyn 2017; 37:89-98. [DOI: 10.1002/nau.23270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/14/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Jochen Neuhaus
- Department of UrologyResearch Laboratory, University LeipzigLeipzigGermany
| | - Birgit Schröppel
- Natural and Medical Sciences Institute (NMI) at the University of TuebingenReutlingenGermany
| | - Martin Dass
- Carl Zeiss Microscopy GmbH, TrainingApplication and Support Center (TASC) Application Support EMMunichGermany
| | - Hans Zimmermann
- Carl Zeiss Microscopy GmbH, TrainingApplication and Support Center (TASC) Application Support EMMunichGermany
| | - Hartwig Wolburg
- Institute of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | - Petra Fallier‐Becker
- Institute of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | - Thomas Gevaert
- Department of Development and RegenerationKU Leuven, Laboratory of Experimental UrologyLeuvenBelgium
| | - Claus J. Burkhardt
- Natural and Medical Sciences Institute (NMI) at the University of TuebingenReutlingenGermany
| | - Hoang Minh Do
- Department of UrologyUniversity Leipzig, University Hospital LeipzigLeipzigGermany
| | - Jens‐Uwe Stolzenburg
- Department of UrologyUniversity Leipzig, University Hospital LeipzigLeipzigGermany
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71
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Gevaert T, Ridder DD, Vanstreels E, Daelemans D, Everaerts W, Aa FVD, Pintelon I, Timmermans JP, Roskams T, Steiner C, Neuhaus J. The stem cell growth factor receptor KIT is not expressed on interstitial cells in bladder. J Cell Mol Med 2016; 21:1206-1216. [PMID: 27997763 PMCID: PMC5431123 DOI: 10.1111/jcmm.13054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 01/28/2023] Open
Abstract
The mast/stem cell growth factor receptor KIT has long been assumed to be a specific marker for interstitial cells of Cajal (ICC) in the bladder, with possible druggable perspectives. However, several authors have challenged the presence of KIT+ICC in recent years. The aim of this study was therefore to attempt to clarify the conflicting reports on KIT expression in the bladder of human beings, rat, mouse and guinea pig and to elucidate the possible role of antibody‐related issues and interspecies differences in this matter. Fresh samples were obtained from human, rat, mouse and guinea pig cystectomies and processed for single/double immunohistochemistry/immunofluorescence. Specific antibodies against KIT, mast cell tryptase (MCT), anoctamin‐1 (ANO1) and vimentin were used to characterize the cell types expressing KIT. Gut (jejunum) tissue was used as an external antibody control. Our results revealed KIT expression on mast cells but not on ICC in human, rat, mouse and guinea pig bladder. Parallel immunohistochemistry showed KIT expression on ICC in human, rat, mouse and guinea pig gut, which confirmed the selectivity of the KIT antibody clones. In conclusion, we have shown that KIT+ cells in human, rat, mouse and guinea pig bladder are mast cells and not ICC. The present report is important as it opposes the idea that KIT+ICC are present in bladder. In this perspective, functional concepts of KIT+ICC being involved in sensory and/or motor aspects of bladder physiology should be revised.
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Affiliation(s)
- Thomas Gevaert
- Laboratory of Experimental Urology, Organ Systems, KU Leuven, Leuven, Belgium.,Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Organ Systems, KU Leuven, Leuven, Belgium.,Department of Urology, UZ Leuven, Leuven, Belgium
| | - Els Vanstreels
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dirk Daelemans
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Laboratory of Experimental Urology, Organ Systems, KU Leuven, Leuven, Belgium.,Department of Urology, UZ Leuven, Leuven, Belgium
| | - Frank Van Der Aa
- Laboratory of Experimental Urology, Organ Systems, KU Leuven, Leuven, Belgium.,Department of Urology, UZ Leuven, Leuven, Belgium
| | - Isabel Pintelon
- Department of Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Tania Roskams
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Clara Steiner
- Klinik und Poliklinik für Urologie, University of Leipzig, Leipzig, Germany
| | - Jochen Neuhaus
- Klinik und Poliklinik für Urologie, University of Leipzig, Leipzig, Germany
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72
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Does the Technique or Pattern Matter When Injecting OnabotulinumtoxinA? CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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73
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Role of PTHrP and Sensory Nerve Peptides in Regulating Contractility of Muscularis Mucosae and Detrusor Smooth Muscle in the Guinea Pig Bladder. J Urol 2016; 196:1287-94. [DOI: 10.1016/j.juro.2016.04.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 10/24/2022]
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74
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Smolar J, Salemi S, Horst M, Sulser T, Eberli D. Stem Cells in Functional Bladder Engineering. Transfus Med Hemother 2016; 43:328-335. [PMID: 27781020 PMCID: PMC5073506 DOI: 10.1159/000447977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/23/2016] [Indexed: 12/24/2022] Open
Abstract
Conditions impairing bladder function in children and adults, such as myelomeningocele, posterior urethral valves, bladder exstrophy or spinal cord injury, often need urinary diversion or augmentation cystoplasty as when untreated they may cause severe bladder dysfunction and kidney failure. Currently, the gold standard therapy of end-stage bladder disease refractory to conservative management is enterocystoplasty, a surgical enlargement of the bladder with intestinal tissue. Despite providing functional improvement, enterocystoplasty is associated with significant long-term complications, such as recurrent urinary tract infections, metabolic abnormalities, stone formation, and malignancies. Therefore, there is a strong clinical need for alternative therapies for these reconstructive procedures, of which stem cell-based tissue engineering (TE) is considered to be the most promising future strategy. This review is focused on the recent progress in bladder stem cell research and therapy and the challenges that remain for the development of a functional bladder wall.
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Affiliation(s)
- Jakub Smolar
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Souzan Salemi
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Maya Horst
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland
| | - Tullio Sulser
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
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75
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Losada L, Amundsen CL, Ashton-Miller J, Chai T, Close C, Damaser M, DiSanto M, Dmochowski R, Fraser MO, Kielb SJ, Kuchel G, Mueller ER, Parker-Autry C, Wolfe AJ, Mallampalli MP. Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span. J Womens Health (Larchmt) 2016; 25:1086-1096. [PMID: 27285829 PMCID: PMC5116700 DOI: 10.1089/jwh.2016.5895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.
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Affiliation(s)
- Liliana Losada
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
| | - Cindy L Amundsen
- 2 Departments of Obstetrics and Gynecology and Surgery, Duke University , Durham, North Carolina
| | - James Ashton-Miller
- 3 Department of Biomechanical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Toby Chai
- 4 Department of Urology, Yale School of Medicine , New Haven, Connecticut
| | - Clare Close
- 5 Close Pediatric Urology , Las Vegas, Nevada
| | - Margot Damaser
- 6 Department of Biomedical Engineering, Cleveland Clinic and Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio
| | - Michael DiSanto
- 7 Department of Biomedical Sciences and Surgery, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Roger Dmochowski
- 8 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Matthew O Fraser
- 9 Department of Surgery, Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Stephanie J Kielb
- 10 Department of Urology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - George Kuchel
- 11 Department of Geriatrics and Gerontology, UConn Center on Aging , Farmington, Connecticut
| | - Elizabeth R Mueller
- 12 Department Obstetrics/Gynecology and Urology, Loyola University Medical Center, Loyola University Chicago , Maywood, Illinois
| | - Candace Parker-Autry
- 13 Department of Obstetrics and Gynecology, Wake Forest University , Baptist Medical Center, Winston-Salem, North Carolina
| | - Alan J Wolfe
- 14 Department of Microbiology and Immunology, Loyola University Chicago , Maywood, Illinois
| | - Monica P Mallampalli
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
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76
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Merrill L, Gonzalez EJ, Girard BM, Vizzard MA. Receptors, channels, and signalling in the urothelial sensory system in the bladder. Nat Rev Urol 2016; 13:193-204. [PMID: 26926246 DOI: 10.1038/nrurol.2016.13] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The storage and periodic elimination of urine, termed micturition, requires a complex neural control system to coordinate the activities of the urinary bladder, urethra, and urethral sphincters. At the level of the lumbosacral spinal cord, lower urinary tract reflex mechanisms are modulated by supraspinal controls with mechanosensory input from the urothelium, resulting in regulation of bladder contractile activity. The specific identity of the mechanical sensor is not yet known, but considerable interest exists in the contribution of transient receptor potential (TRP) channels to the mechanosensory functions of the urothelium. The sensory, transduction, and signalling properties of the urothelium can influence adjacent urinary bladder tissues including the suburothelial nerve plexus, interstitial cells of Cajal, and detrusor smooth muscle cells. Diverse stimuli, including those that activate TRP channels expressed by the urothelium, can influence urothelial release of chemical mediators (such as ATP). Changes to the urothelium are associated with a number of bladder pathologies that underlie urinary bladder dysfunction. Urothelial receptor and/or ion channel expression and the release of signalling molecules (such as ATP and nitric oxide) can be altered with bladder disease, neural injury, target organ inflammation, or psychogenic stress. Urothelial receptors and channels represent novel targets for potential therapies that are intended to modulate micturition function or bladder sensation.
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Affiliation(s)
- Liana Merrill
- Department of Neurological Sciences, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, Vermont 05405, USA
| | - Eric J Gonzalez
- Department of Neurological Sciences, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, Vermont 05405, USA
| | - Beatrice M Girard
- Department of Neurological Sciences, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, Vermont 05405, USA
| | - Margaret A Vizzard
- Department of Neurological Sciences, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, Vermont 05405, USA
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77
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Michel MC, Korstanje C. β3-Adrenoceptor agonists for overactive bladder syndrome: Role of translational pharmacology in a repositioning clinical drug development project. Pharmacol Ther 2016; 159:66-82. [PMID: 26808167 DOI: 10.1016/j.pharmthera.2016.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
β3-Adrenoceptor agonists were originally considered as a promising drug class for the treatment of obesity and/or type 2 diabetes. When these development efforts failed, they were repositioned for the treatment of the overactive bladder syndrome. Based on the example of the β3-adrenoceptor agonist mirabegron, but also taking into consideration evidence obtained with ritobegron and solabegron, we discuss challenges facing a translational pharmacology program accompanying clinical drug development for a first-in-class molecule. Challenges included generic ones such as ligand selectivity, species differences and drug target gene polymorphisms. Challenges that are more specific included changing concepts of the underlying pathophysiology of the target condition while clinical development was under way; moreover, a paucity of public domain tools for the study of the drug target and aspects of receptor agonists as drugs had to be addressed. Nonetheless, a successful first-in-class launch was accomplished. Looking back at this translational pharmacology program, we conclude that a specifically tailored and highly flexible approach is required. However, several of the lessons learned may also be applicable to translational pharmacology programs in other indications.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany.
| | - Cees Korstanje
- Department of Drug Discovery Science & Management-Europe, Astellas Pharma Europe R&D, Leiden, The Netherlands
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78
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Abstract
Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.
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Affiliation(s)
- Karen M Wallace
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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79
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Chai TC, Russo A, Yu S, Lu M. Mucosal signaling in the bladder. Auton Neurosci 2015; 200:49-56. [PMID: 26422993 DOI: 10.1016/j.autneu.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/27/2015] [Indexed: 01/09/2023]
Abstract
The bladder mucosa is comprised of the multilayered urothelium, lamina propria (LP), microvasculature, and smooth muscle fibers (muscularis mucosae). The muscularis mucosae is not always present in the mucosa, and its presence is related to the thickness of the LP. Since there are no mucus secreting cells, "mucosa" is an imprecise term. Nerve fibers are present in the LP of the mucosa. Efferent nerves mediate mucosal contractions which can be elicited by electrical field stimulation (EFS) and various agonists. The source of mucosal contractility is unknown, but may arise from the muscularis mucosae or myofibroblasts. EFS also increases frequency of mucosal venule contractions. Thus, efferent neural activity has multiple effects on the mucosa. Afferent activity has been measured when the mucosa is stimulated by mechanical and stretch stimuli from the luminal side. Nerve fibers have been shown to penetrate into the urothelium, allowing urothelial cells to interact with nerves. Myofibroblasts are specialized cells within the LP that generate spontaneous electrical activity which then can modulate both afferent and efferent neural activities. Thus mucosal signaling is defined as interactions between bladder autonomic nerves with non-neuronal cells within the mucosa. Mucosal signaling is likely to be involved in clinical functional hypersensory bladder disorders (e.g. overactive bladder, urgency, urgency incontinence, bladder pain syndrome) in which mechanisms are poorly understood despite high prevalence of these conditions. Targeting aberrant mucosal signaling could represent a new approach in treating these disorders.
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Affiliation(s)
- Toby C Chai
- Department of Urology, United States; Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, CT, United States.
| | - Andrea Russo
- Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, CT, United States
| | - Shan Yu
- Department of Urology, United States
| | - Ming Lu
- Department of Urology, United States
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80
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Abstract
Substantial clinical need persists for improved autologous tissues to augment or replace the urinary bladder and research has begun to address this using tissue engineering techniques. The implantation of both tissue scaffolds which allow for native bladder tissue ingrowth and autologous bladder grafts created from in vitro cellularization of such scaffolds have been tested clinically; however, successful outcomes in both scenarios have been challenged by insufficient vascularity resulting from large graft sizes, which subsequently limits tissue ingrowth and leads to central graft ischemia. Consequently, recent research has focused on developing better methods to produce scaffolds with increased tissue ingrowth and vascularity. This review provides an update on bladder tissue engineering and outlines the challenges that remain to clinical implementation.
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81
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Michel MC, Chess-Williams R, Hegde SS. Are blood vessels a target to treat lower urinary tract dysfunction? Naunyn Schmiedebergs Arch Pharmacol 2015; 388:687-94. [PMID: 26026700 DOI: 10.1007/s00210-015-1137-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/12/2023]
Abstract
Bladder dysfunction is common in the general population (Stewart et al. 2010) and even more so among patients seeing a physician for any reason (Goepel et al. 2002). It often manifests as lower urinary tract symptoms (LUTS), a term originally coined to describe voiding and storage symptoms in men with benign prostatic hyperplasia (BPH) but now more universally used to describe any type of voiding and storage symptoms in both sexes. Studies into possible causes of urinary bladder dysfunction have long focused on detrusor smooth muscle cells (Turner and Brading 1999). More recently, it became clear that several other types of cells and organs contribute to regulating detrusor smooth muscle function. These include the urothelium (Andersson and McCloskey 2014; Michel 2015), afferent nerves (Michel and Igawa 2015; Yoshimura et al. 2014b), and the central and autonomic nervous systems (Fowler and Griffiths 2010; Yoshimura et al. 2014a). Alterations in any of these may at least partly be responsible for detrusor dysfunction and, accordingly, be potential targets for the treatment of bladder dysfunction. As highlighted by an article in this issue of Naunyn-Schmiedeberg's Archives of Pharmacology (Bayrak et al. 2015), there is an additional suspect, the bladder vasculature. This article will discuss the currently available experimental and clinical evidence for a role of the vasculature in causing bladder dysfunction, and how existing and emerging treatments may modulate bladder function by acting on blood vessels. Due to a similarity in concept, data on prostate perfusion will also be discussed to some extent.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg Universität, Obere Zahlbacher Str. 67, 55101, Mainz, Germany,
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82
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Gevaert T, Moles Lopez X, Sagaert X, Libbrecht L, Roskams T, Rorive S, Decaestecker C, Salmon I, De Ridder D. Morphometric and quantitative immunohistochemical analysis of disease-related changes in the upper (suburothelial) lamina propria of the human bladder dome. PLoS One 2015; 10:e0127020. [PMID: 25973881 PMCID: PMC4431865 DOI: 10.1371/journal.pone.0127020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/10/2015] [Indexed: 11/19/2022] Open
Abstract
The upper (suburothelial) lamina propria (ULP) is a distinct region in the human bladder with dense populations of interstitial cells (IC), fine vascular networks and variable development of muscularis mucosae (MM). It is more and more obvious that the ULP plays an important role in bladder physiology and bladder disease, and in the present study we have quantified changes in the cellular key players of the ULP in bladders from patients with carcinoma in situ (CIS), multiple sclerosis (MS) and bladder pain syndrome (BPS). Tissue samples for the different patient groups were obtained from radical cystectomy-specimens. Standardized immunohistochemistry with a panel of specific cell markers was used to characterise the ULP cellular structures, followed by digitalised morphometry and quantitative staining analysis. Alterations in the ULP area were most pronounced in MS bladders, but also present in BPS and CIS bladders. We observed an increased thickness and increased variability in thickness of the ULP IC area in MS and BPS bladders; a significantly increased development of MM in MS bladders; a changed organization of vascular plexuses in the lamina propria in most pathologic bladders and a changed phenotype of ULP IC: a significantly decreased expression of progesterone receptor in MS bladders and a trend towards decreased expression of alpha-smooth muscle actin in BPS bladders. We show here for the first time the presence of disease-specific changes in organisation and/or phenotype of the different key players of the ULP area in human bladder. The present findings further support the hypothesis that the ULP area is involved and altered in different bladder diseases.
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Affiliation(s)
- Thomas Gevaert
- Laboratory of experimental urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
- * E-mail:
| | - Xavier Moles Lopez
- DIAPath—Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Xavier Sagaert
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Louis Libbrecht
- Department of Pathology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Tania Roskams
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Sandrine Rorive
- DIAPath—Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Decaestecker
- DIAPath—Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
- Laboratories of Image, Signal processing and Acoustics, Brussels School of Engineering, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Salmon
- DIAPath—Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk De Ridder
- Laboratory of experimental urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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83
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Ferguson AC, Sutton BW, Boone TB, Ford AP, Munoz A. Inhibition of urothelial P2X3 receptors prevents desensitization of purinergic detrusor contractions in the rat bladder. BJU Int 2015; 116:293-301. [DOI: 10.1111/bju.13003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | | | - Timothy B. Boone
- Houston Methodist Research Institute; Houston TX USA
- Houston Methodist Hospital Department of Urology; Houston TX USA
| | | | - Alvaro Munoz
- Houston Methodist Research Institute; Houston TX USA
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84
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Michel MC, Igawa Y. Therapeutic targets for overactive bladder other than smooth muscle. Expert Opin Ther Targets 2015; 19:687-705. [DOI: 10.1517/14728222.2015.1009447] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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85
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Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology 2015; 16:265-84. [PMID: 25666896 PMCID: PMC4361768 DOI: 10.1007/s10522-015-9554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/28/2015] [Indexed: 01/18/2023]
Abstract
The prevalence of both urinary and faecal incontinence, and also chronic constipation, increases with ageing and these conditions have a major impact on the quality of life of the elderly. Management of bladder and bowel dysfunction in the elderly is currently far from ideal and also carries a significant financial burden. Understanding how these changes occur is thus a major priority in biogerontology. The functions of the bladder and terminal bowel are regulated by complex neuronal networks. In particular neurons of the spinal cord and peripheral ganglia play a key role in regulating micturition and defaecation reflexes as well as promoting continence. In this review we discuss the evidence for ageing-induced neuronal dysfunction that might predispose to neurogenic forms of incontinence in the elderly.
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Affiliation(s)
- Richard N Ranson
- Department of Applied Sciences (Biomedical Sciences), Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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86
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Vahabi B, Drake MJ. Physiological and pathophysiological implications of micromotion activity in urinary bladder function. Acta Physiol (Oxf) 2015; 213:360-70. [PMID: 25154454 DOI: 10.1111/apha.12373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/02/2014] [Accepted: 08/19/2014] [Indexed: 12/19/2022]
Abstract
'Micromotions' is a term signifying the presence of localized microcontractions and microelongations, alongside non-motile areas. The motile areas tend to shift over the bladder surface with time, and the intravesical pressure reflects moment-by-moment summation of the interplay between net contractile force generated by micromotions and general bladder tone. Functionally, the bladder structure may comprise modules with variable linkage, which supports presence of localized micromotions (no functional linkage between modules), propagating contractions (where emergence of linkage allows sequential activation) and the shifting of micromotions over time. Detrusor muscle, interstitial cells and intramural innervation have properties potentially relevant for initiating, coordinating and modulating micromotions. Conceptually, such activity could facilitate the generation of afferent activity (filling state reporting) in the absence of intravesical pressure change and the ability to transition to voiding at any bladder volume. This autonomous activity is an intrinsic property, seen in various experimental contexts including the clinical setting of human (female) overactive bladder. 'Disinhibited autonomy' may explain the obvious micromotions in isolated bladders and perhaps contribute clinically in neurological disease causing detrusor overactivity. Furthermore, any process that could increase the initiation or propagation of microcontractions might be anticipated to have a functional effect, increasing the likelihood of urinary urgency and detrusor overactivity respectively. Thus, models of bladder outlet obstruction, neurological trauma and ageing provide a useful framework for detecting cellular changes in smooth muscle, interstitial cells and innervation, and the consequent effects on micromotions.
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Affiliation(s)
- B. Vahabi
- Bristol Urological Institute; North Bristol NHS Trust; Bristol UK
- Department of Biological; Biomedical and Analytical Sciences; University of the West of England; Bristol UK
- School of Clinical Sciences; University of Bristol; Bristol UK
| | - M. J. Drake
- Bristol Urological Institute; North Bristol NHS Trust; Bristol UK
- School of Clinical Sciences; University of Bristol; Bristol UK
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87
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Arrighi S. The urothelium: anatomy, review of the literature, perspectives for veterinary medicine. Ann Anat 2014; 198:73-82. [PMID: 25533627 DOI: 10.1016/j.aanat.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/31/2014] [Accepted: 11/20/2014] [Indexed: 01/13/2023]
Abstract
Over time, much knowledge has been accumulated about the active role of the urothelium, principally in rodents and human. Far from being a mere passive barrier, this specialized epithelium can alter the ion and protein composition of the urine, is able to sense and respond to mechanical stimuli such as pressure, and react to mechanical stimuli by epithelial cell communication with the nervous system. Most of the specialized functions of the urothelium are linked to a number of morpho-physiologic properties exhibited by the superficial umbrella cells, including specialized membrane lipids, asymmetric unit membrane particles and a plasmalemma with stiff plaques which function as a barrier to most substances found in urine, thus protecting the underlying tissues. Moreover, the entire mucosa lining the low urinary tract, composed of urothelium and sub-urothelium, forms a functional transduction unit, able to respond to eso- and endogenous physical and chemical stimuli in a manner assuring an adequate functional response. This review will summarize the available information on each area of inquiry from a morpho-functional point of view. Possible considerations pertaining to species of veterinary interest are reviewed as well. The review was prepared consulting the electronic databases PubMed and Cab Abstracts and retrieving all pertinent reports and the relative reference lists, in order to identify any potential additional studies that could be included. Full-length research articles and thematic reviews were considered. Information on the urothelium of some domestic animal species was also included.
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Affiliation(s)
- S Arrighi
- Department of Health, Animal Science and Food Safety, Laboratory of Anatomy and Confocal Microscopy, Università degli Studi di Milano, Milano, Italy.
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88
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Bexten M, Oswald S, Grube M, Jia J, Graf T, Zimmermann U, Rodewald K, Zolk O, Schwantes U, Siegmund W, Keiser M. Expression of Drug Transporters and Drug Metabolizing Enzymes in the Bladder Urothelium in Man and Affinity of the Bladder Spasmolytic Trospium Chloride to Transporters Likely Involved in Its Pharmacokinetics. Mol Pharm 2014; 12:171-8. [DOI: 10.1021/mp500532x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Oliver Zolk
- Institute
of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nuremberg, Erlangen, Germany
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89
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Gevaert T, Vanstreels E, Daelemans D, Franken J, Van Der Aa F, Roskams T, De Ridder D. Identification of Different Phenotypes of Interstitial Cells in the Upper and Deep Lamina Propria of the Human Bladder Dome. J Urol 2014; 192:1555-63. [DOI: 10.1016/j.juro.2014.05.096] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Thomas Gevaert
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Els Vanstreels
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dirk Daelemans
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Jan Franken
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frank Van Der Aa
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tania Roskams
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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90
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Michel MC. Therapeutic modulation of urinary bladder function: multiple targets at multiple levels. Annu Rev Pharmacol Toxicol 2014; 55:269-87. [PMID: 25251997 DOI: 10.1146/annurev-pharmtox-010814-124536] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Storage dysfunction of the urinary bladder, specifically overactive bladder syndrome, is a condition that occurs frequently in the general population. Historically, pathophysiological and treatment concepts related to overactive bladder have focused on smooth muscle cells. Although these are the central effector, numerous anatomic structures are involved in their regulation, including the urothelium, afferent and efferent nerves, and the central nervous system. Each of these structures involves receptors for—and the urothelium itself also releases—many mediators. Moreover, hypoperfusion, hypertrophy, and fibrosis can affect bladder function. Established treatments such as muscarinic antagonists, β-adrenoceptor agonists, and onabotulinumtoxinA each work in part through their effects on the urothelium and afferent nerves, as do α1-adrenoceptor antagonists in the treatment of voiding dysfunction associated with benign prostatic hyperplasia; however, none of these treatments are specifically targeted to the urothelium and afferent nerves. It remains to be explored whether future treatments that specifically act at one of these structures will provide a therapeutic advantage.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, 55101 Mainz, Germany;
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91
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Gonzalez EJ, Merrill L, Vizzard MA. Bladder sensory physiology: neuroactive compounds and receptors, sensory transducers, and target-derived growth factors as targets to improve function. Am J Physiol Regul Integr Comp Physiol 2014; 306:R869-78. [PMID: 24760999 PMCID: PMC4159737 DOI: 10.1152/ajpregu.00030.2014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/19/2014] [Indexed: 01/19/2023]
Abstract
Urinary bladder dysfunction presents a major problem in the clinical management of patients suffering from pathological conditions and neurological injuries or disorders. Currently, the etiology underlying altered visceral sensations from the urinary bladder that accompany the chronic pain syndrome, bladder pain syndrome (BPS)/interstitial cystitis (IC), is not known. Bladder irritation and inflammation are histopathological features that may underlie BPS/IC that can change the properties of lower urinary tract sensory pathways (e.g., peripheral and central sensitization, neurochemical plasticity) and contribute to exaggerated responses of peripheral bladder sensory pathways. Among the potential mediators of peripheral nociceptor sensitization and urinary bladder dysfunction are neuroactive compounds (e.g., purinergic and neuropeptide and receptor pathways), sensory transducers (e.g., transient receptor potential channels) and target-derived growth factors (e.g., nerve growth factor). We review studies related to the organization of the afferent limb of the micturition reflex and discuss neuroplasticity in an animal model of urinary bladder inflammation to increase the understanding of functional bladder disorders and to identify potential novel targets for development of therapeutic interventions. Given the heterogeneity of BPS/IC and the lack of consistent treatment benefits, it is unlikely that a single treatment directed at a single target in micturition reflex pathways will have a mass benefit. Thus, the identification of multiple targets is a prudent approach, and use of cocktail treatments directed at multiple targets should be considered.
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Affiliation(s)
- Eric J Gonzalez
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont
| | - Liana Merrill
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont
| | - Margaret A Vizzard
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont
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92
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Hammad FT, Stephen B, Lubbad L, Morrison JFB, Lammers WJ. Macroscopic electrical propagation in the guinea pig urinary bladder. Am J Physiol Renal Physiol 2014; 307:F172-82. [PMID: 24899061 DOI: 10.1152/ajprenal.00215.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There is little knowledge about macroscopic electrical propagation in the wall of the urinary bladder. Recording simultaneously from a large number of extracellular electrodes is one technology that could be used to study the patterns of macroscopic electrical propagations. The urinary bladders from 14 guinea pigs were isolated and placed in an organ bath. A 16 × 4-electrode array was positioned at various sites on the serosal bladder surface, and recordings were performed at different intravesical volumes. In four experiments, carbachol (CCH; 10(-6) M), nifedipine (10 mM), or tetrodotoxin (TTX; 10(-6) M) was added to the superfusing fluid. After the experiments, the extracellular signals were analyzed and propagation maps were constructed. Electrical waves were detected at all sites on the bladder surface and propagated for a limited distance before terminating spontaneously. The majority of waves (>90%) propagated in the axial direction (i.e., from dome to base or vice versa). An increase in vesicle volume significantly decreased the conduction velocity (from 4.9 ± 1.5 to 2.7 ± 0.7 cm/s; P < 0.05). CCH increased, nifedipine decreased, while TTX had little effect on electrical activities. In addition, a new electrical phenomenon, termed a "patch," was discovered whereby a simultaneous electrical deflection was detected across an area of the bladder surface. Two types of electrical activities were detected on the bladder surface: 1) electrical waves propagating preferentially in the axial direction and 2) electrical patches. The propagating electrical waves could form the basis for local spontaneous contractions in the bladder during the filling phase.
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Affiliation(s)
- F T Hammad
- Department of Surgery, United Arab Emirates University, Al Ain, United Arab Emirates; and
| | - B Stephen
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - L Lubbad
- Department of Surgery, United Arab Emirates University, Al Ain, United Arab Emirates; and
| | - J F B Morrison
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - W J Lammers
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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93
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Birder LA, Andersson KE, Kanai AJ, Hanna-Mitchell AT, Fry CH. Urothelial mucosal signaling and the overactive bladder-ICI-RS 2013. Neurourol Urodyn 2014; 33:597-601. [PMID: 24838393 DOI: 10.1002/nau.22604] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/11/2014] [Indexed: 11/09/2022]
Abstract
There is abundant evidence that the lower urinary tract (LUT) mucosal layer is involved both in mechanosensory functions that regulate bladder contractile activity and in urethral sensation. Changes to the mucosa can be associated with a number of bladder pathologies. For example, alterations of the urothelium and underlying lamina propria at both the molecular and structural levels have been reported in both patients and animals associated with disorders such as bladder pain syndrome and diabetic cystopathy. In contrast to the urinary bladder, much less is known about the urothelium/lamina propria of the bladder neck/proximal urethra. There are important gender differences in the outflow region both anatomically and with respect to innervation, hormonal sensitivity, and location of the external urethral sphincter. There is reasonable evidence to support the view that the mucosal signaling pathway in the proximal urethra is important for normal voiding, but it has also been speculated that the proximal urethra can initiate bladder overactivity. When dysfunctional, the proximal urethra may be an interesting target, for example, botulinum toxin injections aiming at eliminating both urgency and incontinence due to detrusor overactivity.
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Affiliation(s)
- Lori A Birder
- Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Departments of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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94
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Sunagawa M, Wolf-Johnston A, Nomiya M, Sawada N, Andersson KE, Hisamitsu T, Birder LA. Urinary bladder mucosal responses to ischemia. World J Urol 2014; 33:275-80. [PMID: 24728265 DOI: 10.1007/s00345-014-1298-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The objectives of this study were to examine the expression of various cellular proteins within the urothelium (UT) and lamina propria (LP) following chronic bladder ischemia in the rat urinary bladder. MATERIALS AND METHODS Urinary bladders were removed from adult Sprague-Dawley rats 8 weeks after creation of bladder ischemia and from sham controls. Immunocytochemistry was used to examine distribution of LP-vimentin-immunoreactive (IR) cells and connexins (Cx26; Cx43), and western immunoblotting or ELISA for proteins involved in UT barrier and sensory functions. RESULTS Ischemia was associated with a significant increase in LP-vimentin-IR cells and increased expression of the gap junction proteins Cx26 and Cx43 within the bladder UT as compared to sham control. Ischemia also resulted in an increased (p < 0.05) expression level of the junctional marker (ZO-1) and non-significantly increased expressions of the trophic factor nerve growth factor as well as norepinephrine. CONCLUSIONS Our findings reveal that chronic ischemia alters a number of proteins within the UT and underlying LP. These proteins are involved in barrier function, remodeling, repair as well as intercellular communication. The increased expression of LP-vimentin-IR cells suggests that changes in cell-cell interactions could play a role in ischemia-induced changes in bladder activity.
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Affiliation(s)
- Masataka Sunagawa
- Departments of Medicine, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
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95
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The role(s) of cytokines/chemokines in urinary bladder inflammation and dysfunction. BIOMED RESEARCH INTERNATIONAL 2014; 2014:120525. [PMID: 24738044 PMCID: PMC3971501 DOI: 10.1155/2014/120525] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/26/2014] [Accepted: 02/05/2014] [Indexed: 12/17/2022]
Abstract
Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a chronic pain syndrome characterized by pain, pressure, or discomfort perceived to be bladder related and with at least one urinary symptom. It was recently concluded that 3.3-7.9 million women (>18 years old) in the United States exhibit BPS/IC symptoms. The impact of BPS/IC on quality of life is enormous and the economic burden is significant. Although the etiology and pathogenesis of BPS/IC are unknown, numerous theories including infection, inflammation, autoimmune disorder, toxic urinary agents, urothelial dysfunction, and neurogenic causes have been proposed. Altered visceral sensations from the urinary bladder (i.e., pain at low or moderate bladder filling) that accompany BPS/IC may be mediated by many factors including changes in the properties of peripheral bladder afferent pathways such that bladder afferent neurons respond in an exaggerated manner to normally innocuous stimuli (allodynia). The goals for this review are to describe chemokine/receptor (CXCL12/CXCR4; CCL2/CCR2) signaling and cytokine/receptor (transforming growth factor (TGF-β)/TGF-β type 1 receptor) signaling that may be valuable LUT targets for pharmacologic therapy to improve urinary bladder function and reduce somatic sensitivity associated with urinary bladder inflammation.
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96
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Jerman UD, Veranič P, Kreft ME. Amniotic membrane scaffolds enable the development of tissue-engineered urothelium with molecular and ultrastructural properties comparable to that of native urothelium. Tissue Eng Part C Methods 2013; 20:317-27. [PMID: 23947657 DOI: 10.1089/ten.tec.2013.0298] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The amniotic membrane (AM) is a naturally derived biomaterial that possesses biological and mechanical properties of great importance for tissue engineering. The aim of our study was to determine whether the AM enables the formation of a normal urinary bladder epithelium-urothelium--and to reveal any differences in the urothelial cell (UC) growth and differentiation when using different AM scaffolds. Cryopreserved human AM was used as a scaffold in three different ways. Normal porcine UCs were seeded on the AM epithelium (eAM), denuded AM (dAM), and stromal AM (sAM) and were cultured for 3 weeks. UC growth on AM scaffolds was monitored daily. By using electron microscopy, histochemical and immunofluorescence techniques, we here provide evidence that all three AM scaffolds enable the development of the urothelium. The fastest growth and the highest differentiation of UCs were demonstrated on the sAM scaffold, which enables the development of tissue-engineered urothelium with molecular and ultrastructural properties comparable to that of the native urothelium. Most importantly, the highly differentiated urothelia on the sAM scaffolds provide important experimental models for future drug delivery studies and developing tissue engineering strategies considering that subtle differences are identified before translation to the clinical settings.
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Affiliation(s)
- Urška Dragin Jerman
- 1 Institute of Cell Biology, Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia
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