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Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disease characterized by pelvic pain, usually with urinary frequency. These symptoms make patients suffer from a poor quality of life. However, there is still a lack of consensus on the pathophysiology and curable treatment of IC/BPS. We have reviewed several candidates for the pathophysiology of this disease and also treatments that have been used. Although several oral medications, bladder instillation therapies, fulguration for Hunner's lesion, and hydrodistention have been tried as IC/BPS treatments, their outcomes have not been satisfactory. As the application of stem cell therapy is expanding into the urologic field, innovative strategies have been tested with animal models of IC/BPS and have shown promising therapeutic effects for reversing the symptoms of this disorder. Although several concerns about stem cell sources and their safety should be addressed before initiating human clinical trials, we introduce stem cell therapy as a valuable future treatment approach for IC/BPS.
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Affiliation(s)
- Aram Kim
- Departments of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-RO 43 GIL SONGPA-GU, Seoul, 05505, South Korea
| | - Dong-Myung Shin
- Departments of Biomedical Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Soo Choo
- Departments of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-RO 43 GIL SONGPA-GU, Seoul, 05505, South Korea.
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Mishra NN. Clinical presentation and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in India. Transl Androl Urol 2016; 4:512-23. [PMID: 26816851 PMCID: PMC4708552 DOI: 10.3978/j.issn.2223-4683.2015.10.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterized by pelvic pain urgency and frequency. Patients with severe symptoms lead a very miserable life. North American, European and Asian guidelines have been recently promulgated but they differ on many important issues. There is no consensus on its name, definition, investigations and management. Indian guidelines have also been developed and they give more importance to the symptoms in relation to micturition. Though initially believed to be rare or non-existent in India the situation has changed. In Indian patients the presentation is more or less same as the rest of the world but a large percentage have obstructive symptoms and unusual urinary symptoms. Anal discomfort is also common. In India the commonest investigation in all cases of lower urinary tract (LUT) dysfunction is ultrasonography of kidney ureter and bladder with measurement of the post void residual urine volume. Cystoscopy is also done in all the cases to rule out presence of tuberculosis or carcinoma in situ. Bladder pain syndrome/interstitial cystitis (BPS/IC) is not considered to be a clinical disease as it is difficult to rule out all differential diagnosis only from history. Hunner’s lesion is very rare. Cystoscopy with hydro distension, oral therapy, intravesical therapy and surgical therapy form the back bone of management. It is difficult to know which treatment is best for a given patient. A staged protocol is followed and all the treatment modalities are applied to the patients in a sequential fashion—starting from the non-invasive to more invasive. Intravesical botox has not been found to be effective and there is no experience with interstim neuromodulation.
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Fariello JY, Moldwin RM. Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management. Transl Androl Urol 2016; 4:643-52. [PMID: 26816866 PMCID: PMC4708545 DOI: 10.3978/j.issn.2223-4683.2015.10.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) and vulvodynia are chronic pain syndromes that appear to be intertwined from the perspectives of embryology, pathology and epidemiology. These associations may account for similar responses to various therapies.
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Affiliation(s)
- Jennifer Yonaitis Fariello
- 1 Academic Urology at Bryn Mawr, The Center for Pelvic Medicine, Rosemont, PA, USA ; 2 Hofstra North Shore-LIJ School of Medicine, Pelvic Pain Treatment Center, The Arthur Smith Institute for Urology, North Shore-LIJ Healthcare System, New Hyde Park, NY, USA
| | - Robert M Moldwin
- 1 Academic Urology at Bryn Mawr, The Center for Pelvic Medicine, Rosemont, PA, USA ; 2 Hofstra North Shore-LIJ School of Medicine, Pelvic Pain Treatment Center, The Arthur Smith Institute for Urology, North Shore-LIJ Healthcare System, New Hyde Park, NY, USA
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Charrua A, Pinto R, Birder LA, Cruz F. Sympathetic nervous system and chronic bladder pain: a new tune for an old song. Transl Androl Urol 2016; 4:534-42. [PMID: 26816852 PMCID: PMC4708549 DOI: 10.3978/j.issn.2223-4683.2015.09.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chronic bladder pain (CBP) patients present with pelvic pain or discomfort during bladder filling, for at least a period of 6 months, which may be accompanied by lower urinary tract symptoms such as frequency, nocturia, and urgency. However, both the etiology of CBP and pathophysiological mechanisms are not well described. A number of clinical and basic animal model findings support involvement of sympathetic nervous system in chronic pain syndromes such as CBP. Examples include sympathetic overactivity and high plasma or urinary catecholamine levels that have a high correlation with nociceptive symptoms. In this review, we explored the current evidence in support of the involvement of sympathetic overactivity in CBP. As bladder inflammation often occurs among subgroups of CBP patients, we discuss the possible role of sympathetic nervous system in mastocytosis as well examples examples of animal models that further support the involvement of sympathetic dysfunction in CBP. As there is substantive evidence for cross-organ sensitization in the pelvis can lead to co-morbidity of genitourinary and gastrointestinal dysfunctions, we also include how sympathetic dysfunction may play a role in a number of co-morbid chronic pain syndromes.
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Affiliation(s)
- Ana Charrua
- 1 I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal ; 2 IBMC-Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal ; 3 Department of Renal, Urologic and Infectious diseases, Faculty of Medicine of University of Porto, Porto, Portugal ; 4 Department of Urology, Hospital S. João, Porto, Portugal ; 5 Departments of Medicine and Pharmacology-Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rui Pinto
- 1 I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal ; 2 IBMC-Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal ; 3 Department of Renal, Urologic and Infectious diseases, Faculty of Medicine of University of Porto, Porto, Portugal ; 4 Department of Urology, Hospital S. João, Porto, Portugal ; 5 Departments of Medicine and Pharmacology-Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lori Ann Birder
- 1 I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal ; 2 IBMC-Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal ; 3 Department of Renal, Urologic and Infectious diseases, Faculty of Medicine of University of Porto, Porto, Portugal ; 4 Department of Urology, Hospital S. João, Porto, Portugal ; 5 Departments of Medicine and Pharmacology-Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Francisco Cruz
- 1 I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal ; 2 IBMC-Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal ; 3 Department of Renal, Urologic and Infectious diseases, Faculty of Medicine of University of Porto, Porto, Portugal ; 4 Department of Urology, Hospital S. João, Porto, Portugal ; 5 Departments of Medicine and Pharmacology-Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Abstract
Mast cells (MCs) are ubiquitous in the body, but they have historically been associated with allergies, and most recently with regulation of immunity and inflammation. However, it remains a puzzle why so many MCs are located in the diencephalon, which regulates emotions and in the genitourinary tract, including the bladder, prostate, penis, vagina and uterus that hardly ever get allergic reactions. A number of papers have reported that MCs have estrogen, gonadotropin and corticotropin-releasing hormone (CRH) receptors. Moreover, animal experiments have shown that diencephalic MCs increase in number during courting in doves. We had reported that allergic stimulation of nasal MCs leads to hypothalamic-pituitary adrenal (HPA) activation. Interestingly, anecdotal information indicates that female patients with mastocytosis or mast cell activation syndrome may have increased libido. Preliminary evidence also suggests that MCs may have olfactory receptors. MCs may, therefore, have been retained phylogenetically not only to “smell danger”, but to promote survival and procreation.
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Affiliation(s)
- Theoharis C Theoharides
- 1 Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA ; 2 Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Julia M Stewart
- 1 Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA ; 2 Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
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56
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Liu HT, Kuo HC. Biomarkers for patients with interstitial cystitis/bladder pain syndrome. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ogawa T, Ishizuka O, Ueda T, Tyagi P, Chancellor MB, Yoshimura N. Current and emerging drugs for interstitial cystitis/bladder pain syndrome (IC/BPS). Expert Opin Emerg Drugs 2015; 20:555-70. [DOI: 10.1517/14728214.2015.1105216] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Michishita M, Tomita KI, Yano K, Kasahara KI. Mast Cell Accumulation and Degranulation in Rat Bladder with Partial Outlet Obstruction. Adv Ther 2015; 32 Suppl 1:16-28. [PMID: 26507185 DOI: 10.1007/s12325-015-0243-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia causes partial bladder outlet obstruction (pBOO), and many patients with pBOO are affected by not only voiding symptoms but also storage symptoms. We previously suggested that enhancement of 5-hydroxytryptamine (5-HT)-induced bladder contraction in the pBOO bladder may be one cause of storage symptoms. However, little is known about the presence of 5-HT in rat bladders. In this study, we hypothesized that mast cells are a source of 5-HT and investigated the distribution of mast cells and 5-HT in the bladders of rats with pBOO. METHODS The bladders of female Sprague-Dawley rats were subjected to pBOO and sham operations for 1 week, were isolated, and were fixed for light or electron microscopy. Mast cells and 5-HT in the bladders were detected by toluidine blue staining and immunohistochemical staining, respectively. The mast cells were counted under a light microscope. Degranulated mast cells were observed under an electron microscope and counted under a light microscope. RESULTS Mast cells were present in the mucosa/submucosa region in sham rat bladders. Their number was increased in the detrusor muscle/subserosa/serosa region, especially the subserosal layer, in pBOO rat bladders. The localization of mast cells almost matched that of 5-HT-positive cells in consecutive sections. Degranulated mast cells were present in sham and pBOO rat bladders, but the proportion of degranulated mast cells was significantly increased in every region in pBOO rat bladders compared with that in sham rat bladders. CONCLUSION These results suggest that mast cells contain 5-HT and are more abundant locally in the subserosal layer of pBOO rat bladders. 5-HT released from mast cells could stimulate 5-HT2 receptors on the detrusor muscle, and this may underlie storage symptoms. FUNDING Asahi Kasei Pharma Corp.
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Affiliation(s)
- Mai Michishita
- Laboratory for Pharmacology, Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1, Mifuku, Izunokuni-shi, Shizuoka, 410-2321, Japan
| | - Ken-Ichi Tomita
- Laboratory for Pharmacology, Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1, Mifuku, Izunokuni-shi, Shizuoka, 410-2321, Japan
| | - Kazuo Yano
- Laboratory for Pharmacology, Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1, Mifuku, Izunokuni-shi, Shizuoka, 410-2321, Japan
| | - Ken-Ichi Kasahara
- Laboratory for Pharmacology, Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1, Mifuku, Izunokuni-shi, Shizuoka, 410-2321, Japan.
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Tamma SM, Shorter B, Toh KL, Moldwin R, Gordon B. Influence of polyunsaturated fatty acids on urologic inflammation. Int Urol Nephrol 2015; 47:1753-61. [DOI: 10.1007/s11255-015-1108-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/03/2015] [Indexed: 01/03/2023]
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Interleukin-33 and Mast Cells Bridge Innate and Adaptive Immunity: From the Allergologist's Perspective. Int Neurourol J 2015; 19:142-50. [PMID: 26620895 PMCID: PMC4582085 DOI: 10.5213/inj.2015.19.3.142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/04/2015] [Indexed: 01/29/2023] Open
Abstract
Interleukin (IL) 33, a member of the IL-1 superfamily, is an “alarmin” protein and is secreted in its active form from damaged cells undergoing necrotic cell death. Mast cells are one of the main effector cell types in allergic disorders. They secrete a variety of mediators, including T helper 2 cytokines. As mast cells have high-affinity IgE receptors (FcεRI) on their surface, they can capture circulating IgE. IgE-bound mast cells degranulate large amounts of histamine, heparin, and proteases when they encounter antigens. As IL-33 is an important mediator of innate immunity and mast cells play an important role in adaptive immune responses, interactions between the two could link innate and adaptive immunity. IL-33 promotes the adhesion of mast cells to laminin, fibronectin, and vitronectin. IL-33 increases the expression of adhesion molecules, such as intracellular adhesion molecule-1 and vascular cell adhesion molecule-1, in endothelial cells, thus enhancing mast cell adhesion to blood vessel walls. IL-33 stimulates mast cell proliferation by activating the ST2/Myd88 pathway; increases mast cell survival by the activation of survival proteins such as Bcl-XL; and promotes the growth, development, and maturation of mast cell progenitors. IL-33 is also involved in the activation of mature mast cells and production of different proinflammatory cytokines. The interaction of IL-33 and mast cells could have important clinical implications in the field of clinical urology. Epithelial dysfunction and mast cells could play an important role in the pathogenesis of interstitial cystitis. Urinary levels of IL-33 significantly increase in patients with interstitial cystitis. In addition, the number of mast cells significantly increase in the urinary bladders of patients with interstitial cystitis. Therefore, inhibition of mast cell activation and degranulation in response to increase in IL-33 is a potential therapeutic target in the treatment of interstitial cystitis.
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Marentette JO, Hurst RE, McHowat J. Impaired Expression of Prostaglandin E2 (PGE2) Synthesis and Degradation Enzymes during Differentiation of Immortalized Urothelial Cells from Patients with Interstitial Cystitis/Painful Bladder Syndrome. PLoS One 2015; 10:e0129466. [PMID: 26057882 PMCID: PMC4461170 DOI: 10.1371/journal.pone.0129466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/08/2015] [Indexed: 12/12/2022] Open
Abstract
Purpose The differentiated superficial cells of the urothelium restrict urine flow into the bladder wall. We have demonstrated that urothelial cells isolated from bladders of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) fail to release PGE2 in response to tryptase. This study examines the expression of PGE2 synthesis and degradation enzymes in urothelial cells during differentiation. Materials and Methods We measured immunoprotein expression of cyclooxygenase-2 (COX-2), prostaglandin E2 synthase (PGES) and 15-hydroxyprostaglandin dehydrogenase (PGDH) in human urothelial cells and in immortalized urothelial cells isolated from the bladders of IC/PBS patients or normal subjects during stratification and differentiation produced by increased calcium and fetal bovine serum (Ca/FBS) in the culture medium for 1, 3 and 7 days. Results PGES immunoprotein expression increased during differentiation in normal and IC/PBS urothelial cells. COX-2 expression also increased in cells from normal patients following differentiation. Remarkably, no COX-2 expression was detectable in urothelial cells isolated from 3 out of 4 IC/PBS patients. PGDH immunoprotein expression decreased in normal cells after 1 and 3 days of Ca/FBS addition, but returned to normal after 7 days. PGDH expression was unchanged during differentiation at 1 and 3 days, but was more than 2-fold higher at 7 days compared to day 0 in the IC/PBS cells. Urothelial cells isolated from IC/PBS patients demonstrated no PGE2 release in response to tryptase under any of the experimental conditions studied. Conclusions Taken together, our results indicate that PGE2 release is compromised during stratification and differentiation in IC/PBS urothelium and may contribute to impaired barrier function.
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Affiliation(s)
- John O. Marentette
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd., St. Louis, MO 63104, United States of America
| | - Robert E. Hurst
- Department of Urology, Oklahoma University Health Sciences Center, 940 S. L. Young Blvd., Oklahoma City, OK, 73104, United States of America
| | - Jane McHowat
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd., St. Louis, MO 63104, United States of America
- * E-mail:
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Yoshimura N, Oguchi T, Yokoyama H, Funahashi Y, Yoshikawa S, Sugino Y, Kawamorita N, Kashyap MP, Chancellor MB, Tyagi P, Ogawa T. Bladder afferent hyperexcitability in bladder pain syndrome/interstitial cystitis. Int J Urol 2015; 21 Suppl 1:18-25. [PMID: 24807488 DOI: 10.1111/iju.12308] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022]
Abstract
Bladder pain syndrome/interstitial cystitis is a disease with lower urinary tract symptoms, such as bladder pain and urinary frequency, which results in seriously impaired quality of life of patients. The extreme pain and urinary frequency are often difficult to treat. Although the etiology of bladder pain syndrome/interstitial cystitis is still not known, there is increasing evidence showing that afferent hyperexcitability as a result of neurogenic bladder inflammation and urothelial dysfunction is important to the pathophysiological basis of symptom development. Further investigation of the pathophysiology will lead to the effective treatment of patients with bladder pain syndrome/interstitial cystitis.
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Affiliation(s)
- Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Logadottir Y, Delbro D, Lindholm C, Fall M, Peeker R. Inflammation characteristics in bladder pain syndrome ESSIC type 3C/classic interstitial cystitis. Int J Urol 2015; 21 Suppl 1:75-8. [PMID: 24807505 DOI: 10.1111/iju.12370] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/04/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Interstitial cystitis is regarded as a heterogenous syndrome with two distinguishable forms: the non-ulcer and the classic form of interstitial cystitis, the latter with Hunner's lesions; or bladder pain syndrome type 3C and non-Hunner bladder pain syndrome, respectively. METHODS A cohort of 379 patients diagnosed with interstitial cystitis was studied. Nitric oxide release from the bladder was measured using a chemiluminescence nitric oxide analyzer. Bladder biopsies from the patients and healthy controls were analyzed by routine histopathological examination. Biopsies from a subset of patients and controls were also analyzed by immunohistochemistry and cytokine gene expression by real-time polymerase chain reaction. RESULTS Patients with bladder pain syndrome type 3C/classic interstitial cystitis had considerably higher levels of nitric oxide as compared with non-Hunner bladder pain syndrome/non-ulcer interstitial cystitis patients and healthy individuals, and showed histologically a chronic inflammation in the bladder mucosa, with abundant mast cell infiltration in all layers of the bladder wall. No inflammation was noted in non-Hunner bladder pain syndrome/non-ulcer interstitial cystitis patients. The isoenzymes inducible nitric oxide synthase, the catalyst in the nitric oxide production, was strongly expressed in the inflammatory cells in the bladder mucosa of bladder pain syndrome type 3C/classic interstitial cystitis patients. In addition, the expression of the pro-inflammatory cytokines interleukin-6 and interleukin-17A messenger ribonucleic acid, and of anti-inflammatory interleukin-10 messenger ribonucleic acid showed significantly increased levels in bladder pain syndrome type 3C/classic interstitial cystitis compared with healthy controls. CONCLUSION Bladder pain syndrome type 3C/classic interstitial cystitis is a distinct inflammatory disease and in many aspects shares features of inflammatory autoimmune diseases. These findings could open up novel research avenues with expectations for new targets for pharmacological treatment.
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Affiliation(s)
- Yr Logadottir
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Koca O, Gokce AM, Akyuz M, Ercan F, Yurdakul N, Karaman MI. A new problem in inflammatory bladder diseases: use of mobile phones! Int Braz J Urol 2015; 40:520-5. [PMID: 25251956 DOI: 10.1590/s1677-5538.ibju.2014.04.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 03/16/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Technological developments provide a lot of conveniences to our lives. This issue is one of the risks that arise along with these conveniences. In our study we tried to understand the impact of electromagnetic waves from mobile phones on bladder tissue. MATERIALS AND METHODS Twenty-one adult male albino rats were divided into three equal groups. Group 1 was exposed to electromagnetic wave for 8 hours per day for 20 days and then their bladders were taken off immediately. Group 2 was firstly exposed to electromagnetic wave for 8 hours per day for 20 days then secondly another for 20 days without exposition to electromagnetic wave and then their bladders were taken off. Group 3 was the control group and they were not exposed to electromagnetic wave. RESULTS Under microscopic examination of bladder tissue, in the first group severe inflammatory cell infiltration was seen in lamina propria and muscle layer in contrast to intact urothelium. In the second group mild inflammatory cell infiltration was seen in lamina propria and muscle layer. The mean scores for the three groups were 5.5 ± 2.5, 0.8 ± 1.3 and 1.2 ± 1.5 respectively. Mean score of group 1 was statistically higher than others (p = 0.001). CONCLUSION Intensive use of mobile phones has negative impact on bladder tissue as well as the other organs. Keeping a minimum level of mobile phone use makes it easy to be kept under control of diseases in which inflammation is an etiologic factor.
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Affiliation(s)
- Orhan Koca
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ali Murat Gokce
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Akyuz
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Feriha Ercan
- Department of Histology and Embryology, Marmara University School of Medicine, Istanbul, Turkey
| | - Necati Yurdakul
- Department of Histology and Embryology, Marmara University School of Medicine, Istanbul, Turkey
| | - Muhammet Ihsan Karaman
- SDepartment of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Gamper M, Regauer S, Welter J, Eberhard J, Viereck V. Are mast cells still good biomarkers for bladder pain syndrome/interstitial cystitis? J Urol 2015; 193:1994-2000. [PMID: 25596361 DOI: 10.1016/j.juro.2015.01.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE ESSIC identifies mast cell infiltrates of detrusor muscle as a diagnostic criterion for bladder pain syndrome/interstitial cystitis. However, an increased mast cell count is also characteristic of overactive bladder syndrome. The lack of uniformity in mast cell detection methods hampers data comparison. Using state-of-the-art techniques we investigated whether mast cells differ among bladder conditions. MATERIALS AND METHODS We analyzed bladder biopsies from 56 patients, including 31 with bladder pain syndrome/interstitial cystitis with (12) or without (19) Hunner lesions, 13 with overactive bladder syndrome and 12 without bladder symptoms to determine the quantity, location, distribution and activation of mast cells using immunohistochemistry with anti-mast cell tryptase. Patients were allocated to study groups by key bladder symptoms commonly used to define conditions (pain and major urgency). RESULTS Subepithelial mast cell localization (p <0.001) and an increased detrusor mast cell count (p = 0.029) were characteristic of bladder pain syndrome/interstitial cystitis with Hunner lesions. The optimal cutoff of 32 detrusor mast cells per mm(2) achieved only 68% accuracy with 38% positive predictive value. No difference was observed between bladder pain syndrome/interstitial cystitis without Hunner lesions and overactive bladder syndrome. Patient groups differed in lymphocyte infiltration (p = 0.001), nodular lymphocyte aggregates (p <0.001) and urothelium integrity (p <0.001). CONCLUSIONS Subepithelial mast cell distribution was characteristic of bladder pain syndrome/interstitial cystitis with Hunner lesions. Detrusor mastocytosis had poor predictive value for bladder pain syndrome/interstitial cystitis. Mast cell assessment did not distinguish bladder pain syndrome/interstitial cystitis without Hunner lesions from overactive bladder syndrome.
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Affiliation(s)
- Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria.
| | - Sigrid Regauer
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria
| | - JoEllen Welter
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria
| | - Jakob Eberhard
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria
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Li M, Yang K, Wang X, Xu X, Zhu L, Wang H. Mast cells infiltration and decreased E-cadherin expression in ketamine-induced cystitis. Toxicol Rep 2014; 2:205-209. [PMID: 28962353 PMCID: PMC5598405 DOI: 10.1016/j.toxrep.2014.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022] Open
Abstract
Background Ketamine is a controlled substance and often illegally used as a recreational drug primarily by young adults. Increasing ketamine abusers associated with lower urinary tract symptoms have been reported at hospitals in recent years. Here we used a murine model to explore the changes of bladder in order to elucidate its pathogenesis. Methods ICR mice were randomly distributed into control and ketamine groups and received daily intraperitoneal injection of saline and ketamine (30 mg/kg), respectively. The bladders were excised and processed for histology at 4, 8 and 12 weeks. Tryptase and E-cadherin were investigated by immunohistochemistry in bladder tissues from ketamine-treated and control mice to assess the mast cell activation and junction protein expression. Results After ketamine treatment, the bladder changed to be hyperemic, inflamed, and with more fissures in mucosa. Compared with control group, the number of tryptase-positive mast cells significantly increased, which was 6.98 ± 2.89 and 23.00 ± 6.48 cells per field (100×) at 8 and 12 weeks, respectively (P = 0.016 and P = 0.003, respectively). Additionally, the expression of E-cadherin in ketamine-treated mice bladder tissue was significantly lower than that in the control tissues, P < 0.001. Conclusions Increased mast cells in bladder wall and downregulated expression of E-cadherin junction protein in epithelial cells were probably associated with interstitial inflammation and fissures in mucosa. It implied that ketamine induced an interstitial cystitis.
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Affiliation(s)
- Mengqiang Li
- Department of Urology, The Union Hospital of Fujian Medical University, Fuzhou, PR China
| | - Kang Yang
- Department of Immunology, Fujian Medical University, Fuzhou, PR China
| | - Xiujian Wang
- Department of Immunology, Fujian Medical University, Fuzhou, PR China
| | - Xiaodong Xu
- Department of Anesthesiology, The Union Hospital of Fujian Medical University, Fuzhou, PR China
| | - Ling Zhu
- Department of Immunology, Fujian Medical University, Fuzhou, PR China
| | - Huili Wang
- Department of Immunology, Fujian Medical University, Fuzhou, PR China
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Bicer F, Altuntas CZ, Izgi K, Ozer A, Kavran M, Tuohy VK, Daneshgari F. Chronic pelvic allodynia is mediated by CCL2 through mast cells in an experimental autoimmune cystitis model. Am J Physiol Renal Physiol 2014; 308:F103-13. [PMID: 25209862 DOI: 10.1152/ajprenal.00202.2014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The cause of chronic pelvic pain in interstitial cystitis/painful bladder syndrome (IC/PBS) remains unclear; autoimmunity is a possible etiology. We have recently shown that injection of a single immunogenic peptide of uroplakin 3A (UPK3A 65-84) induces experimental autoimmune cystitis (EAC) in female BALB/cJ mice that is unique among experimental models in accurately reflecting both the urinary symptoms and pelvic pain of IC/PBS. The aim of this project was to identify the roles of mast cells and mast cell chemoattractant/activator monocyte chemoattractant protein-1 [chemokine (C-C motif) ligand 2 (CCL2)] in the allodynia in this model. We immunized 6- to 8-wk-old female BALB/cJ mice with UPK3A 65-84 peptide and, 5-40 days later, observed increased responses to stimulation of the suprapubic abdominal and hindpaw surfaces with von Frey monofilaments compared with mice injected with adjuvant alone. Suprapubic and hindpaw tactile allodynia responses by EAC mice were blocked by instillation of lidocaine into the bladder but not by lidocaine in the uterus, confirming the bladder as the source of the hypersensitivity. Markedly increased numbers of activated mast cells and expression of CCL2 were found in the bladder after immunization with UPK3A 65-84. Hypersensitive responses were inhibited by mast cell stabilizer cromolyn sodium and antagonists of histamine receptors 1 and 2. Furthermore, BALB/cJ mice with deletion of the Ccl2 or chemokine (C-C motif) receptor 2 gene exhibited markedly reduced allodynia and accumulation of mast cells after UPK3A 65-84 immunization. These results show that UPK3A 65-84 immunization causes chronic visceral allodynia and suggest that it is mediated by CCL2-driven mast cell accumulation in the bladder.
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Affiliation(s)
- Fuat Bicer
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Clinical Chemistry, Cleveland State University, Cleveland, Ohio
| | - Cengiz Z Altuntas
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kenan Izgi
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Clinical Chemistry, Cleveland State University, Cleveland, Ohio
| | - Ahmet Ozer
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Genetics, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Michael Kavran
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vincent K Tuohy
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Firouz Daneshgari
- Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio;
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Affiliation(s)
- Rui Moncao Sul
- School of Veterinary MedicineUniversity of Glasgow464 Bearsden RoadGlasgowG61 1QHUK
| | - Gawain Hammond
- School of Veterinary MedicineUniversity of Glasgow464 Bearsden RoadGlasgowG61 1QHUK
| | - Kathryn Pratschke
- School of Veterinary MedicineUniversity of Glasgow464 Bearsden RoadGlasgowG61 1QHUK
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Choi BH, Jin LH, Kim KH, Han JY, Kang JH, Yoon SM, Park CS, Lee T. Mast cell activation and response to tolterodine in the rat urinary bladder in a chronic model of intravesical protamine sulfate and bacterial endotoxin-induced cystitis. Mol Med Rep 2014; 10:670-6. [PMID: 24859757 DOI: 10.3892/mmr.2014.2262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 03/27/2014] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to use an animal model of interstitial cystitis (IC) in order to investigate the histology and function of the bladder, with a particular focus on mast cell degranulation and response to detrusor overactivity (DO) to tolterodine. A total of 18 female Sprague‑Dawley rats were used. In 12 rats, lipopolysaccharide (LPS) was intravesically instilled following the induction of IC by protamine sulfate (PS) and six rats were subjected to sham instillations. Following 1 month, cystometry was performed. The effects of tolterodine were tested in half of the animals with IC. All rats in the IC group demonstrated DO during the filling phase and no significant changes in the frequency or pressure compared with that following tolterodine injection were identified. Histological examination revealed a significant increase in the total number of infiltrated mast cells in IC rats compared with that in the sham rats (P<0.05). Degranulated mast cells were evident in 80% of rats with IC; however, they were not apparent in the sham rats. Urinary bladder inflammation, similar to that in human IC in terms of degranulated mast cells and bladder function, was induced in rats. The animal model used in the present study provided insight into the pathophysiological mechanisms underlying the ineffectiveness of anticholinergics in patients with overlapping IC and overactive bladder (OAB).
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Affiliation(s)
- Bo-Hwa Choi
- Department of Pharmacology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
| | - Long-Hu Jin
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Khae-Hawn Kim
- Department of Urology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
| | - Jee-Young Han
- Department of Pathology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
| | - Ju-Hee Kang
- Department of Pharmacology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
| | - Sang-Min Yoon
- Department of Urology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
| | - Chang-Shin Park
- Department of Pharmacology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
| | - Tack Lee
- Department of Urology, Inha University College of Medicine by BK 21 Project, Incheon 400-711, South Korea
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Effect of inflammatory mediators on ATP release of human urothelial RT4 cells. BIOMED RESEARCH INTERNATIONAL 2014; 2014:182862. [PMID: 24839598 PMCID: PMC4009244 DOI: 10.1155/2014/182862] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/02/2014] [Indexed: 12/24/2022]
Abstract
Inflammation is an important contributor to the aetiology of a number of bladder dysfunctions including interstitial cystitis, painful bladder syndrome, and overactive bladder. The aim of this study was to examine the effects of inflammatory mediators on urothelial ATP release. Human urothelial RT4 cells were exposed to normal buffer or varying concentrations of inflammatory mediators (bradykinin, histamine, and serotonin) in the presence or absence of hypotonic stretch stimuli (1 : 2 dilution of Krebs-Henseleit buffer). Others have demonstrated that bradykinin increased stretch-induced ATP release; however, we observed no change in control or stretch-induced ATP release with bradykinin. Pretreatment of RT4 cells with histamine or serotonin decreased stretch-induced ATP release (P = 0.037, P = 0.040, resp.). Previous studies have demonstrated increased ATP release in response to inflammation utilising whole bladder preparations in contrast to our simple model of cultured urothelial cells. The current study suggests that it is unlikely that there is a direct interaction between the release of inflammatory mediators and increased ATP release, but rather more complex interactions occurring in response to inflammation that lead to increased bladder sensation.
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Golubeva AV, Zhdanov AV, Mallel G, Dinan TG, Cryan JF. The mouse cyclophosphamide model of bladder pain syndrome: tissue characterization, immune profiling, and relationship to metabotropic glutamate receptors. Physiol Rep 2014; 2:e00260. [PMID: 24760514 PMCID: PMC4002240 DOI: 10.1002/phy2.260] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/17/2014] [Indexed: 01/08/2023] Open
Abstract
Abstract Painful bladder syndrome/Interstitial cystitis (PBS/IC) is a chronic disorder characterized clinically by recurring episodes of pelvic pain and increased urination frequency, significantly impairing patients' quality of life. Despite this, there is an unmet medical need in terms of effective diagnostics and treatment. Animal models are crucial in this endeavor. Systemic chronic administration of cyclophosphamide (CYP) in mice has been proposed as a relevant preclinical model of chronic bladder pain. However, molecular mechanisms underlying the pathogenesis of this model are lacking. Here, we show that mice, subjected to repetitive systemic injections of CYP, developed mild inflammatory response in bladder tissue characterized by submucosal edema, moderate increase in proinflammatory cytokine gene expression, and mastocytosis. No signs of massive inflammatory infiltrate, tissue hemorrhages, mucosal ulcerations and urothelium loss were observed. Instead, CYP treatment induced urothelium hyperplasia, accompanied by activation of proliferative signaling cascades, and a decrease in the expression of urothelium-specific markers. Metabotropic glutamate (mGlu) receptors have been implicated in chronic pain disorders. CYP administration induced differential changes in mGlu receptors mRNA levels in bladder tissue, without affecting gene expression at spinal cord level, pointing to the potential link between peripheral mGlu receptors and inflammation-induced bladder malfunction and hyperalgesia. Taken together, these data indicate that chronic CYP treatment in mice is a model of PBS mostly relevant to the major, nonulcerative subtype of the syndrome, characterized by a relatively unaltered mucosa and a sparse inflammatory response. This model can help to elucidate the pathogenetic mechanisms of the disease.
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Affiliation(s)
- Anna V. Golubeva
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | | | - Giuseppe Mallel
- Pathology Unit, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Timothy G. Dinan
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - John F. Cryan
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
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Tseng LH. Advances in the methods for discovering novel painful bladder syndrome therapies. Expert Opin Drug Discov 2014; 9:423-32. [DOI: 10.1517/17460441.2014.894975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nasrin S, Masuda E, Kugaya H, Osano A, Ito Y, Yamada S. Effects of Saw Palmetto Extract on Urodynamic Parameters, Bladder Muscarinic and Purinergic Receptors and Urinary Cytokines in Rats with Cyclophosphamide-Induced Cystitis. Low Urin Tract Symptoms 2014; 6:57-63. [PMID: 26663502 DOI: 10.1111/luts.12015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To clarify the effect of saw palmetto extract (SPE), a phytotherapeutic agent, on urodynamic parameters, bladder muscarinic and purinergic receptors, and urinary cytokines in rats with cystitis induced by cyclophosphamide (CYP). METHODS Saw palmetto extract (60 mg/kg per day) was administered orally twice a day for 7 days to rats. The urodynamic parameters in CYP (150 mg/kg i.p.)-treated rats were monitored by a cystometric method under anesthesia. The muscarinic and purinergic receptors in the bladder and submaxillary gland were measured by radioreceptor assays using [N-methyl-(3) H] scopolamine chloride([(3) H]NMS) and αβ-methylene-ATP [2,8-(3) H] tetrasodium salt ([(3) H]αβ-MeATP), respectively. Urinary cytokines (interleukin-1β [IL-1β], IL-6 and L-17) were measured with enzyme linked immunosorbent assay kits. RESULTS Micturition interval and micturition volume were significantly decreased and the frequency of micturition and basal pressure were significantly increased in the CYP-treated rats compared with sham-operated rats. Orally administered SPE significantly increased the micturition interval and micturition volume and decreased the frequency of micturition and basal pressure. The maximal number of sites (Bmax ) for the specific binding of [(3) H]NMS and [(3) H]αβ-MeATP was significantly decreased in the bladder. The decrease in receptors was attenuated by repeated treatment with SPE. An elevation in urinary cytokine (IL-1β and IL-17) levels were seen, and this increase was effectively suppressed by SPE treatment. CONCLUSIONS Saw palmetto extract attenuates the alteration of urodynamic parameters, pharmacologically relevant receptors, and urinary cytokines in CYP-treated rats. Therefore, SPE may be a potential therapeutic agent for improving the clinical symptoms of cystitis.
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Affiliation(s)
- Sweety Nasrin
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Eiji Masuda
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Haruna Kugaya
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Ayaka Osano
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yoshihiko Ito
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Shizuo Yamada
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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Singh UP, Singh NP, Guan H, Hegde VL, Price RL, Taub DD, Mishra MK, Nagarkatti M, Nagarkatti PS. The severity of experimental autoimmune cystitis can be ameliorated by anti-CXCL10 Ab treatment. PLoS One 2013; 8:e79751. [PMID: 24278169 PMCID: PMC3836899 DOI: 10.1371/journal.pone.0079751] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/02/2013] [Indexed: 12/21/2022] Open
Abstract
Background Interstitial cystitis (IC), more recently called painful bladder syndrome (PBS) is a complex disease associated with chronic bladder inflammation that primarily affects women. Its symptoms include frequent urinary urgency accompanied by discomfort or pain in the bladder and lower abdomen. In the United States, eight million people, mostly women, have IC/PBS. New evidence that autoimmune mechanisms are important in the pathogenesis of IC/PBS triggered interest. Methodology/Principal Findings SWXJ mice immunized with a homogenate of similar mice’s urinary bladders develop an autoimmune phenotype comparable to clinical IC with functional and histological alterations confined to the urinary bladder. Using the murine model of experimental autoimmune cystitis (EAC), we found that serum levels of CXCR3 ligand and local T helper type 1 (Th1) cytokine are elevated. Also, IFN-γ-inducible protein10 (CXCL10) blockade attenuated overall cystitis severity scores; reversed the development of IC; decreased local production of CXCR3 and its ligands, IFN-γ, and tumor necrosis factor-α (TNF-α); and lowered systemic levels of CXCR3 ligands. Urinary bladder CD4+ T cells, mast cells, and neutrophils infiltrates were reduced following anti-CXCL10 antibody (Ab) treatment of mice. Anti-CXCL10 Ab treatment also reversed the upregulated level of CXCR3 ligand mRNA at urinary bladder sites. The decreased number and percentage of systemic CD4+ T cells in EAC mice returned to normal after anti-CXCL10 Ab treatment. Conclusion/Significance Taken together, our findings provide important new information about the mechanisms underlying EAC pathogenesis, which has symptoms similar to those of IC/PBS. CXCL10 has the potential for use in developing new therapy for IC/PBS.
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Affiliation(s)
- Udai P. Singh
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Narendra P. Singh
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
| | - Honbing Guan
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
| | - Venkatesh L. Hegde
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
| | - Robert L. Price
- Department of Cell and Developmental Biology, University of South Carolina, Columbia, South Carolina, United States of America
| | - Dennis D. Taub
- Hematology and Immunology Research, VA Medical Center, Department of Veteran Affairs, Washington DC, United States of America
| | - Manoj K. Mishra
- Department of Math and Sciences, Alabama State University, Montgomery, Alabama, United States of America
| | - Mitzi Nagarkatti
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
| | - Prakash S. Nagarkatti
- Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
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A focus on mast cells and pain. J Neuroimmunol 2013; 264:1-7. [PMID: 24125568 DOI: 10.1016/j.jneuroim.2013.09.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 12/13/2022]
Abstract
Mast cells (MCs) are immunocytes with secretory functions that act locally in peripheral tissues to modulate local hemodynamics, nociceptor activation and pain. They are also able to infiltrate the central nervous system (CNS), especially the spinal cord and the thalamus, but their cerebral function remains an enigma. A role in regulating the opening of the blood-brain barrier has been proposed. Paracrine-like action of MCs on synaptic transmission might also signal a modulation of the nervous system by the immune system. In this review, we examine the link between MCs and nociceptive process, at the periphery as well as in the CNS.
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Chung KH, Liu SP, Lin HC, Chung SD. Bladder pain syndrome/interstitial cystitis is associated with anxiety disorder. Neurourol Urodyn 2013; 33:101-5. [PMID: 24038135 DOI: 10.1002/nau.22382] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/17/2013] [Indexed: 01/27/2023]
Abstract
AIM Recent research demonstrated that bladder pain syndrome/interstitial cystitis (BPS/IC) is associated with many coexisting physical and psychiatric conditions. In this study, we explored the potential association between anxiety disorder (AD) and BPS/IC using a case-controlled population-based approach in Taiwan. METHODS Data on the sampled subjects analyzed in this study were retrieved from the Longitudinal Health Insurance Database 2000. Our study included 396 female cases with BPS/IC and 1,980 randomly selected female controls. We excluded subjects who had a history of major psychosis (except AD) or a substance-related disorder. A conditional logistic regression was performed to calculate the odds ratio (OR) for the association between a previous diagnosis of AD and IC/BPS. RESULTS Of the 2,376 sampled subjects, 136 (5.72%) had received an AD diagnosis. AD was found in 64 (16.16%) cases and in 72 (3.64%) controls (P < 0.001). The conditional logistic regression analysis (conditioned on age group and the index year) suggested that compared to controls, the OR for prior AD among cases was 4.59 (95% confidence interval (CI) = 2.32-9.08, P < 0.001). After adjusting for chronic pelvic pain, irritable bowel syndrome, fibromyalgia, migraines, sicca syndrome, allergies, asthma, and an overactive bladder, the OR for prior AD among cases was 4.37 (95% CI = 2.16-8.85, P < 0.001) compared to the controls. CONCLUSIONS There was an association between AD and BPS/IC, even after taking demographic characteristics, medical co-morbidities, and substance-related disorders into consideration. Results of this study should alert clinicians to evaluate and monitor the presence of BPS/IC in patients with AD.
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Affiliation(s)
- Kuo-Hsuan Chung
- Departmentof Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Lee CL, Jiang YH, Kuo HC. Increased apoptosis and suburothelial inflammation in patients with ketamine-related cystitis: a comparison with non-ulcerative interstitial cystitis and controls. BJU Int 2013; 112:1156-62. [PMID: 23937072 DOI: 10.1111/bju.12256] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the suburothelial inflammation and urothelial dysfunction that occurs with ketamine-related cystitis (KC) and interstitial cystitis/bladder pain syndrome (IC/BPS). PATIENTS AND METHODS Bladder tissues from 16 patients with KC, 17 patients with IC/BPS and 10 control subjects were analysed. Immunofluorescence staining of the junction protein E-cadherin was carried out, and tryptase levels and a TUNEL assay were used to assess mast-cell activation and urothelial apoptosis, respectively. The fluorescence intensity of E-cadherin was measured using the ImageJ method. The percentages of activated mast cells and apoptotic cells were calculated as positive cells per unit area (4 μm(2) ). RESULTS The mean (sd) ages of the patients in the KC, IC/BPS and control groups were 25.0 (3.8), 41.3 (13.7) and 50.5 (9.6) years, respectively (P < 0.05). The mean (sd) distributions of E-cadherin in KC (10.1 [11.2]) and IC/BPS (25.1 [16.3]) tissues were significantly lower than in the control tissues (42.4 [16.7]; both P < 0.05). The mean (sd) number of activated mast cells, measured by tryptase signals in the KC (6.5 [3.7]) and IC/BPS (4.6 [3.0]) tissues, were significantly higher than in the control tissues (1.3 [1.12]; both P < 0.05). TUNEL staining showed a significantly higher mean (sd) number of apoptotic cells in KC (4.4 [2.5]) and IC/BPS (2.4 [1.7]) tissues than in control tissues (0.1 [0.3]; both P < 0.05). Tissues from the KC bladders had significantly lower expression of E-cadherin (P = 0.024) and significantly higher numbers of apoptotic cells (P = 0.02) compared with the IC/BPS bladder tissues. Greater numbers of apoptotic cells and lower expression levels of E-cadherin significantly correlated with maximum bladder capacity in the overall patient samples (P < 0.05). CONCLUSIONS KC and IC/BPS tissues both showed defective junction protein, increased suburothelial inflammation and increased urothelial cell apoptosis. Decreased expression of E-cadherin and increased apoptosis were more severe in KC than in IC/BPS bladder tissues and these findings were associated with the clinical symptoms of KC and IC/BPS.
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Affiliation(s)
- Cheng-Ling Lee
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Marentette JO, Hauser PJ, Hurst RE, Klumpp DJ, Rickard A, McHowat J. Tryptase activation of immortalized human urothelial cell mitogen-activated protein kinase. PLoS One 2013; 8:e69948. [PMID: 23922867 PMCID: PMC3726738 DOI: 10.1371/journal.pone.0069948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/18/2013] [Indexed: 12/20/2022] Open
Abstract
The pathogenesis of interstitial cystitis/painful bladder syndrome (IC/PBS) is multifactorial, but likely involves urothelial cell dysfunction and mast cell accumulation in the bladder wall. Activated mast cells in the bladder wall release several inflammatory mediators, including histamine and tryptase. We determined whether mitogen-activated protein (MAP) kinases are activated in response to tryptase stimulation of urothelial cells derived from human normal and IC/PBS bladders. Tryptase stimulation of normal urothelial cells resulted in a 2.5-fold increase in extracellular signal regulated kinase 1/2 (ERK 1/2). A 5.5-fold increase in ERK 1/2 activity was observed in urothelial cells isolated from IC/PBS bladders. No significant change in p38 MAP kinase was observed in tryptase-stimulated normal urothelial cells but a 2.5-fold increase was observed in cells isolated from IC/PBS bladders. Inhibition of ERK 1/2 with PD98059 or inhibition of p38 MAP kinase with SB203580 did not block tryptase-stimulated iPLA2 activation. Incubation with the membrane phospholipid-derived PLA2 hydrolysis product lysoplasmenylcholine increased ERK 1/2 activity, suggesting the iPLA2 activation is upstream of ERK 1/2. Real time measurements of impedance to evaluate wound healing of cell cultures indicated increased healing rates in normal and IC/PBS urothelial cells in the presence of tryptase, with inhibition of ERK 1/2 significantly decreasing the wound healing rate of IC/PBS urothelium. We conclude that activation of ERK 1/2 in response to tryptase stimulation may facilitate wound healing or cell motility in areas of inflammation in the bladder associated with IC/PBS.
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Affiliation(s)
- John O. Marentette
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
| | - Paul J. Hauser
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Robert E. Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - David J. Klumpp
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Alice Rickard
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
| | - Jane McHowat
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
- * E-mail:
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Bosch PC. A randomized, double-blind, placebo controlled trial of adalimumab for interstitial cystitis/bladder pain syndrome. J Urol 2013; 191:77-82. [PMID: 23792149 DOI: 10.1016/j.juro.2013.06.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The efficacy of adalimumab for the treatment of interstitial cystitis/bladder pain syndrome was investigated in a phase III, randomized, double-blind, placebo controlled, proof of concept study. MATERIALS AND METHODS Patients with interstitial cystitis/bladder pain syndrome were randomized to receive a loading dose of 80 mg subcutaneous adalimumab followed by 40 mg every 2 weeks or subcutaneous placebo for 12 weeks, and outcome measures were assessed. The incidence of adverse events was also assessed. RESULTS Of a total of 43 patients 21 received adalimumab and 22 received placebo. Of the patients who received adalimumab, there was a statistically significant improvement demonstrated in the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indexes (p = 0.0002), Interstitial Cystitis Symptom Index (p = 0.0011), Interstitial Cystitis Problem Index (p = 0.0002), and Pelvic Pain, Urgency, Frequency Symptom Scale (p = 0.0017) at 12 weeks compared to baseline. At 12 weeks 11 of 21 (53%) patients in the adalimumab group had a 50% or greater improvement in global response assessment (p ≤ 0.0001). There was not a statistically significant improvement in any outcome measure in patients receiving adalimumab compared to placebo. There were no significant adverse events. CONCLUSIONS Adalimumab treatment resulted in a statistically significant improvement in outcome measures compared to baseline in patients with moderate to severe interstitial cystitis/bladder pain syndrome. Adalimumab failed to demonstrate positive proof of concept compared to placebo due to a significant placebo effect.
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Affiliation(s)
- Philip C Bosch
- Department of Urology, Palomar Medical Center, Escondido, California.
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Crumley S, Ge Y, Zhou H, Shen SS, Ro JY. Interstitial cystitis: another IgG4-related inflammatory disease? Ann Diagn Pathol 2013; 17:403-7. [PMID: 23732167 DOI: 10.1016/j.anndiagpath.2013.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/01/2013] [Indexed: 01/08/2023]
Abstract
Interstitial cystitis (IC) is a disease of undetermined etiology and pathogenesis. Inflammation is thought to play a key role in many patients, characteristically with an increase in mast cells within the detrusor muscle of the bladder. We observed that some patients with IC had prominent plasma cells in bladder tissue, which elicited our interest in their possible pathogenic role in patients with IC. A total of 44 cases of IC were collected, including 42 bladder biopsies and 2 cystectomies. Patient age ranged from 18 to 92 years (average age of 49.5 years) and included 7 male and 37 female patients. The histology and immunostains for IgG, IgG4 and tryptase were examined, and the results were correlated with clinical and cystoscopic findings. Four cases showed a significant increase in IgG4-positive plasma cells, with greater than 30 IgG4 plasma cells per high-power field and an IgG4/IgG ratio greater than 0.5. In addition, statistically significant differences were found between IC with IgG4-positive plasma cells vs IgG4-negative cases. The IgG4-positive patients were of older age and had increased severe inflammation and decreased bladder capacity as compared with the IgG4-negative patients. We propose that a subset of patients with IC may have an IgG4-related disease, and further study including serum IgG4 measurement is required to better define this relationship.
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Affiliation(s)
- Suzanne Crumley
- Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX
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Shimizu N, De Velasco MA, Umekawa T, Uemura H, Yoshikawa K. Effects of the Rho kinase inhibitor, hydroxyfasudil, on bladder dysfunction and inflammation in rats with HCl-induced cystitis. Int J Urol 2013; 20:1136-43. [PMID: 23419011 DOI: 10.1111/iju.12119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 01/20/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effect of the Rho kinase inhibitor, hydroxyfasudil, on bladder function in a rat model of HCl-induced chemical cystitis, and to elucidate the possible mechanisms associated with its therapeutic effect. METHODS Female Sprague-Dawley rats with HCl-induced cystitis were given hydroxyfasudil (10 mg/kg, i.p.) for 7 days. Treatment efficacy was determined by comparing bladder function and histopathology to sham and untreated control rats. Bladder function was determined by cystometric analysis. Rho kinase activity was determined by quantitative reverse transcription polymerase chain reaction and signal inhibition of downstream Ras homolog member A/Rho kinase signaling molecules by western blot and immunohistochemistry. RESULTS Treatment with hydroxyfasudil significantly improved bladder intercontraction intervals. Rats treated with hydroxyfasudil also showed a significant reduction of histopathological features associated with cystitis. Western blot and immunohistochemistry findings showed that hydroxyfasudil inhibited downstream molecules of Rho kinase that ameliorated changes associated with HCl-induced chemical cystitis, such as inflammatory cell recruitment and smooth muscle cell proliferation. CONCLUSION The findings from the present study suggest a promising therapeutic role for hydroxyfasudil in bladder inflammation associated with cystitis.
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Affiliation(s)
- Nobutaka Shimizu
- Department of Urology, Kinki University Faculty of Medicine, Osaka, Japan
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83
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Oottamasathien S, Jia W, Roundy LM, Zhang J, Wang L, Ye X, Hill AC, Savage J, Lee WY, Hannon AM, Milner S, Prestwich GD. Physiological relevance of LL-37 induced bladder inflammation and mast cells. J Urol 2013; 190:1596-1602. [PMID: 23313203 DOI: 10.1016/j.juro.2013.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE We established the physiological relevance of LL-37 induced bladder inflammation. We hypothesized that 1) human urinary LL-37 is increased in pediatric patients with spina bifida, 2) LL-37 induced inflammation occurs in our mouse model via urothelial binding and is dose dependent and 3) LL-37 induced inflammation involves mast cells. MATERIALS AND METHODS To test our first hypothesis, we obtained urine samples from 56 pediatric patients with spina bifida and 22 normal patients. LL-37 was measured by enzyme-linked immunosorbent assay. Our second hypothesis was tested in C57Bl/6 mice challenged with 7 LL-37 concentrations intravesically for 1 hour. At 24 hours tissues were examined histologically and myeloperoxidase assay was done to quantitate inflammation. In separate experiments fluorescent LL-37 was instilled and tissues were obtained immediately (time = 0) and at 24 hours (time = 24). To test our final hypothesis, we performed immunohistochemistry for mast cell tryptase and evaluated 5 high power fields per bladder to determine the mean number of mast cells per mm(2). RESULTS Urinary LL-37 was 89-fold higher in patients with spina bifida. Mouse LL-37 dose escalation experiments revealed increased inflammation at higher LL-37 concentrations. Fluorescent LL-37 demonstrated global urothelial binding at time = 0 but was not visible at time = 24. Immunohistochemistry for tryptase revealed mast cell infiltration in all tissue layers. At higher concentrations the LL-37 challenge led to significantly greater mast cell infiltration. CONCLUSIONS Urinary LL-37 was significantly increased in pediatric patients with spina bifida. To our knowledge we report for the first time that LL-37 can elicit profound, dose dependent bladder inflammation involving the urothelium. Finally, inflammation propagation involves mast cells.
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Affiliation(s)
- Siam Oottamasathien
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Wanjian Jia
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Lindsi McCoard Roundy
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Jianxing Zhang
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Li Wang
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Xiangyang Ye
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - A Cameron Hill
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Justin Savage
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Wong Yong Lee
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Ann Marie Hannon
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Sylvia Milner
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
| | - Glenn D Prestwich
- Division of Pediatric Urology (SO, WJ, LMR, LW, ACH, AMH, SM) and Departments of Surgery (SO, WJ, LMR, LW, ACH, AMH, SM), Medicinal Chemistry (JZ, GDP) and Pharmacotherapy (XY) and Center for Therapeutic Biomaterials (JZ, GDP), University of Utah/Primary Children's Medical Center and GlycoMira Therapeutics, L.L.C. (JS, WYL), Salt Lake City, Utah
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Abstract
Interstitial cystitis is a condition that affects the urinary bladder and may be more prevalent than commonly thought. Symptoms range widely in severity and typically include urinary urgency, frequency and pelvic pain. Therapies usually target the known pathophysiology of this condition. Oral agents commonly include bladder surface mucin analogues, antihistamines, narcotics, tricyclic antidepressants and anticonvulsants. Intravesical therapy is usually used as second-line treatment. Multiple forms of pharmacotherapy are often provided simultaneously to improve efficacy and time to response.
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85
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Nasrin S, Masuda E, Kugaya H, Ito Y, Yamada S. Improvement by phytotherapeutic agent of detrusor overactivity, down-regulation of pharmacological receptors and urinary cytokines in rats with cyclophosphamide induced cystitis. J Urol 2012; 189:1123-9. [PMID: 23000860 DOI: 10.1016/j.juro.2012.09.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We characterized pharmacological effects of the phytotherapeutic agent Eviprostat® on urodynamic parameters, bladder muscarinic and purinergic receptors, and urinary cytokines in rats with cyclophosphamide induced cystitis. MATERIALS AND METHODS Urodynamic parameters in cyclophosphamide (150 mg/kg intraperitoneally) treated rats were measured by a cystometric method. Muscarinic and purinergic receptors in the bladder and other tissues were measured by radioreceptor assays using [N-methyl-(3)H]scopolamine methyl chloride and [(3)H]αβ-MeATP, respectively. The urinary cytokines interleukin-1β, 6 and 17 were measured with enzyme-linked immunoassay kits. Eviprostat (36 mg/kg per day twice daily for 7 days) was orally administered. RESULTS On cystometry the micturition interval and micturition volume were significantly decreased in cyclophosphamide vs sham treated rats, while micturition frequency, basal pressure and post-void residual urine volume were significantly increased. Repeat oral administration of Eviprostat in cyclophosphamide treated rats significantly increased the micturition interval and micturition volume, and decreased micturition frequency, basal pressure and post-void residual urine volume. The maximal number of binding sites for [N-methyl-(3)H]scopolamine methyl chloride and [(3)H]αβ-MeATP was significantly decreased in the bladder of cyclophosphamide vs sham treated rats. Such decreases were significantly attenuated by repeat Eviprostat treatment. Increased urinary cytokine levels in cyclophosphamide treated rats were also effectively attenuated by Eviprostat. CONCLUSIONS Repeat Eviprostat treatment significantly improved detrusor overactivity, down-regulated the expression of bladder pharmacological receptors and increased urinary cytokine levels in rats with cyclophosphamide induced cystitis. Therefore, Eviprostat may be a pharmacologically useful phytotherapeutic agent for cystitis.
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Affiliation(s)
- Sweety Nasrin
- Department of Pharmacokinetics and Pharmacodynamics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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86
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87
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Yoost JL, Hertweck SP, Loveless M. Diagnosis and treatment of interstitial cystitis in adolescents. J Pediatr Adolesc Gynecol 2012; 25:162-71. [PMID: 21600805 DOI: 10.1016/j.jpag.2011.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
Interstitial cystitis (IC), or painful bladder syndrome, is characterized by irritative voiding symptoms and can be a challenging problem that affects children and adolescents. Diagnosis and management in children and adolescents is challenging because of strict diagnostic criteria and the paucity of investigations focusing on this age group, which often can lead to delayed or missed diagnosis. Clinical features suggestive of IC include bladder pain, urgency, frequency, nocturia, and pressure. Symptoms may wax and wane and often are exacerbated by menstruation, intercourse, dietary triggers, and stress. Diagnosis can be made by history, physical exam findings such as suprapubic tenderness, voiding diaries, and exclusion of other etiologies. Some diagnostic tests such as the potassium sensitivity test and cystoscopy are invasive and often impractical in younger patients. Treatment of IC consists of a multimodal approach that should be tailored to the individual needs of the patient. Therapies for younger patients include oral medication, intravesical therapy, cystoscopy with hydrodistention, and conservative measures such as dietary modification. This review of the literature focuses on diagnosing IC in younger patients and on what treatment modalities are appropriate and effective for this age group.
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Affiliation(s)
- J L Yoost
- Department of Obstetrics, Gynecology and Women's Health, University of Louisville, KY, USA.
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88
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Logadottir Y, Fall M, Kåbjörn-Gustafsson C, Peeker R. Clinical characteristics differ considerably between phenotypes of bladder pain syndrome/interstitial cystitis. ACTA ACUST UNITED AC 2012; 46:365-70. [PMID: 22607036 DOI: 10.3109/00365599.2012.689008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Bladder pain syndrome/interstitial cystitis (BPS/IC) is one of the most bothersome conditions in urological practice. This syndrome includes a heterogeneous collection of underlying pathological conditions. Compared to the classic IC with a Hunner lesion, now denominated European Society for the Study of Interstitial Cystitis (ESSIC) type 3C, the non-Hunner type of BPS/IC appears different concerning demographic, endoscopic and histological findings, as well as the response to all forms of treatment. The objective of this study was to determine whether there are additional dissimilarities in clinical presentation between the main phenotypes of BPS/IC. MATERIAL AND METHODS In total, 393 BPS/IC patients (210 type 3C and 183 non-Hunner), diagnosed according to National Institute of Diabetes and Digestive and Kidney Diseases and ESSIC criteria, were studied by surveying the clinical records including micturition diaries. RESULTS In this clinical material, BPS/IC ESSIC type 3C accounted for 55% of cases. Patients with non-Hunner disease were on average 20 years younger at the time of diagnosis. Furthermore, there was a marked and significant difference in bladder capacity under general anaesthesia (p < 0.0001). CONCLUSIONS The findings in the present series, together with previously published reports by this group and by others, confirm the striking differences between the main forms of BPS/IC and underline the indispensability of adequate subtyping in clinical studies.
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Affiliation(s)
- Yr Logadottir
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
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89
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Anand P, Singh B, Jaggi AS, Singh N. Mast cells: an expanding pathophysiological role from allergy to other disorders. Naunyn Schmiedebergs Arch Pharmacol 2012; 385:657-70. [PMID: 22562473 DOI: 10.1007/s00210-012-0757-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/17/2012] [Indexed: 12/16/2022]
Abstract
The mast cells are multi-effector cells with wide distribution in the different body parts and traditionally their role has been well-defined in the development of IgE-mediated hypersensitivity reactions including bronchial asthma. Due to the availability of genetically modified mast cell-deficient mice, the broadened pathophysiological role of mast cells in diverse diseases has been revealed. Mast cells exert different physiological and pathophysiological roles by secreting their granular contents, including vasoactive amines, cytokines and chemokines, and various proteases, including tryptase and chymase. Furthermore, mast cells also synthesize plasma membrane-derived lipid mediators, including prostaglandins and leukotrienes, to produce diverse biological actions. The present review discusses the pathophysiological role of mast cells in different diseases, including atherosclerosis, pulmonary hypertension, ischemia-reperfusion injury, male infertility, autoimmune disorders such as rheumatoid arthritis and multiple sclerosis, bladder pain syndrome (interstitial cystitis), anxiety, Alzheimer's disease, nociception, obesity and diabetes mellitus.
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Affiliation(s)
- Preet Anand
- Department of Chemistry, Punjabi University, Patiala 147002, India
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90
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Oliva SU, Scarano WR, Okada FK, Miraglia SM. Harmful effects of carbamazepine on the postnatal development of the rat ventral prostate. Reprod Biol Endocrinol 2012; 10:22. [PMID: 22443633 PMCID: PMC3344685 DOI: 10.1186/1477-7827-10-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/25/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Carbamazepine (CBZ) is a first-line antiepileptic drug (AED), although it is also used for the treatments of psychiatric disorders and neuropathic pain. The CBZ utilization has been associated with male reproductive damage, including hormonal alterations, sexual dysfunction and reduction of sperm quality. The wide and long-term use of the CBZ is a common schedule in children and adolescents and alters the testosterone level in adult rats and humans. The objective of this work was to evaluate the CBZ side effects on the ventral prostate of rats from pre-puberty to sexual maturation, since the prostate is an androgen-dependent organ. METHODS Twenty three day-old male albino Wistar rats received CBZ diluted in propylene glycol (20 mg/Kg/i.p via). The treatment lasted 20, 40 and 70 days, according to the different stages of the rat sexual maturation. At the end of each treatment period, ventral prostates were removed and histologically processed. The prostate sections were submitted to the histopathological, morphological and stereological analyses using image analysis system. RESULTS Reductions of the glandular epithelium, glandular lumen and fibromuscular stroma volume of the ventral prostate were observed in adult rats treated with CBZ since the weaning. Triggering and degranulation of mast cells were observed in the fibromuscular stroma of prepubertal and pubertal CBZ treated rats. CONCLUSIONS The results suggest a direct effect of the CBZ on rat ventral prostate, evidenced by increase of mast cell and macrophage populations during pre-puberty and puberty causing a ventral prostate accentuated damage in the adult phase.
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Affiliation(s)
- Samara U Oliva
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Wellerson R Scarano
- Department of Morphology, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fatima K Okada
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandra M Miraglia
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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91
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Klumpp DJ. Re: Shie et al.: Increased cell apoptosis of urothelium mediated by inflammation in interstitial cystitis/painful bladder syndrome (Urology 2012;79:484.e7-484.e13). Urology 2012; 79:748-50; author reply 750-1. [PMID: 22386437 DOI: 10.1016/j.urology.2011.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 12/12/2022]
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92
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Engles CD, Hauser PJ, Abdullah SN, Culkin DJ, Hurst RE. Intravesical chondroitin sulfate inhibits recruitment of inflammatory cells in an acute acid damage "leaky bladder" model of cystitis. Urology 2011; 79:483.e13-7. [PMID: 22137543 DOI: 10.1016/j.urology.2011.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/08/2011] [Accepted: 10/08/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether a physiologic effect of "glycosaminoglycan (GAG) replenishment therapy" altered recruitment of inflammatory cells in an acute bladder damage model. Replacement of the GAG layer with intravesically administered GAGs is an effective therapy for interstitial cystitis in at least some patients. Intravesically administered chondroitin sulfate was previously shown to bind to and restore the impermeability of surface-damaged ("leaky") urothelium to small ions. METHODS Rat bladders were damaged with 10 mM HCl. Negative control bladders were treated with phosphate-buffered saline. On the following day, the animal bladders were treated with 20 mg/mL chondroitin sulfate in phosphate-buffered saline, and the negative and positive controls were treated with phosphate-buffered saline alone. At 2 and 4 days after treatment with chondroitin sulfate, the rats were killed, and sections of their bladders were analyzed using toluidine blue staining for mast cell immunohistochemical labeling using antibodies against CD45 for lymphocytes and myeloperoxidase for neutrophils. RESULTS Chondroitin sulfate treatment reduced the recruitment, in a statistically significant manner, of inflammatory cells, including neutrophils and mast cells to the suburothelial space but did not alter recruitment of CD45-positive lymphocytes. CONCLUSION For the first time, we have demonstrated that intravesical GAG replenishment therapy also produces a physiologic effect of decreasing recruitment of inflammatory cells in an acute model of the damaged bladder. These findings support the use of intravesically administered GAG for bladder disorders that result from a loss of impermeability, including interstitial, radiation, and chemical cystitis, and possibly others as well.
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Affiliation(s)
- Christopher D Engles
- Department of Urology, Oklahoma University Health Science Center, Oklahoma City, Oklahoma 73104, USA
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93
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Grover S, Srivastava A, Lee R, Tewari AK, Te AE. Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol 2011; 3:19-33. [PMID: 21789096 DOI: 10.1177/1756287211398255] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Cystitis, or inflammation of the bladder, has a direct effect on bladder function. Interstitial cystitis is a syndrome characterized by urinary bladder pain and irritative symptoms of more than 6 months duration. It commonly occurs in young to middle-aged women with no known cause and in fact represents a diagnosis of exclusion. Many factors have been suggested, including chronic or subclinical infection, autoimmunity and genetic susceptibility, which could be responsible for initiating the inflammatory response. However, a central role of inflammation has been confirmed in the pathogenesis of interstitial cystitis. Patients with interstitial cystitis are usually managed with multimodal therapy to break the vicious cycle of chronic inflammation at every step. Patients who develop irreversible pathologies such as fibrosis are managed surgically, which is usually reserved for refractory cases.
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Affiliation(s)
- Sonal Grover
- James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, USA
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94
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Nordling J, Fall M, Hanno P. Global concepts of bladder pain syndrome (interstitial cystitis). World J Urol 2011; 30:457-64. [DOI: 10.1007/s00345-011-0785-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/12/2011] [Indexed: 11/24/2022] Open
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95
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New aspects in the differential diagnosis and therapy of bladder pain syndrome/interstitial cystitis. Adv Urol 2011; 2011:639479. [PMID: 22028706 PMCID: PMC3199109 DOI: 10.1155/2011/639479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/08/2011] [Accepted: 07/13/2011] [Indexed: 12/27/2022] Open
Abstract
Diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is presently based on mainly clinical symptoms. BPS/IC can be considered as a worst-case scenario of bladder overactivity of unknown origin, including bladder pain. Usually, patients are partially or completely resistant to anticholinergic therapy, and therapeutical options are especially restricted in case of BPS/IC. Therefore, early detection of patients prone to develop BPS/IC symptoms is essential for successful therapy. We propose extended diagnostics including molecular markers. Differential diagnosis should be based on three diagnostical “columns”: (i) clinical diagnostics, (ii) histopathology, and (iii) molecular diagnostics. Analysis of molecular alterations of receptor expression in detrusor smooth muscle cells and urothelial integrity is necessary to develop patient-tailored therapeutical concepts. Although more research is needed to elucidate the pathomechanisms involved, extended BPS/IC diagnostics could already be integrated into routine patient care, allowing evidence-based pharmacotherapy of patients with idiopathic bladder overactivity and BPS/IC.
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96
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Nelson P, Apte G, Justiz R, Brismeé JM, Dedrick G, Sizer PS. Chronic Female Pelvic Pain-Part 2: Differential Diagnosis and Management. Pain Pract 2011; 12:111-41. [DOI: 10.1111/j.1533-2500.2011.00492.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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97
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Potential targeting of siglecs, mast cell inhibitory receptors, in interstitial cystitis. Int Neurourol J 2011; 15:61-3. [PMID: 21811694 PMCID: PMC3138845 DOI: 10.5213/inj.2011.15.2.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 06/20/2011] [Indexed: 11/08/2022] Open
Abstract
Mast cell increases and activation are detected in the chronic inflammatory bladder disease interstitial cystitis (IC), and their proinflammatory mediators are felt to contribute to regional pelvic pain and inflammatory pathophysiology. The immunoreceptor tyrosine-based inhibition motif-containing sialic acid-binding immunoglobulin-like lectins (Siglecs) expressed in mast cells could be evaluated as in vivo signaling regulators capable of inhibiting IC-related mast cell activation.
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98
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New insights into the mechanism of the down-regulation of mast cells in the treatment of interstitial cystitis: possible role of siglecs. Int Neurourol J 2011; 15:59-60. [PMID: 21811693 PMCID: PMC3138844 DOI: 10.5213/inj.2011.15.2.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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99
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5-Hydroxytryptamine potentiates neurogenic contractions of rat isolated urinary bladder through both 5-HT7 and 5-HT2C receptors. Eur J Pharmacol 2011; 650:403-10. [DOI: 10.1016/j.ejphar.2010.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 10/05/2010] [Accepted: 10/06/2010] [Indexed: 11/21/2022]
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100
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Geurts N, Van Dyck J, Wyndaele JJ. Bladder pain syndrome: do the different morphological and cystoscopic features correlate? ACTA ACUST UNITED AC 2010; 45:20-3. [DOI: 10.3109/00365599.2010.519346] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nicolas Geurts
- Department of Urology, Faculty of Medicine, University Antwerp and Antwerp University Hospital, Belgium
| | - Johan Van Dyck
- Department of Urology, Faculty of Medicine, University Antwerp and Antwerp University Hospital, Belgium
| | - Jean-Jacques Wyndaele
- Department of Urology, Faculty of Medicine, University Antwerp and Antwerp University Hospital, Belgium
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