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Hughes FM, Allkanjari A, Odom MR, Mulcrone JE, Jin H, Purves JT. Male Akita mice develop signs of bladder underactivity independent of NLRP3 as a result of a decrease in neurotransmitter release from efferent neurons. Am J Physiol Renal Physiol 2023; 325:F61-F72. [PMID: 37167271 PMCID: PMC10292983 DOI: 10.1152/ajprenal.00284.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
Diabetic bladder dysfunction (DBD) is a prevalent diabetic complication that is recalcitrant to glucose control. Using the Akita mouse model (type 1) bred to be NLR family pyrin domain containing 3 (NLRP3)+/+ or NLRP3-/-, we have previously found that females (mild hyperglycemia) progress from an overactive to underactive bladder phenotype and that this progression was dependent on NLRP3-induced inflammation. Here, we examined DBD in the male Akita mouse (severe hyperglycemia) and found by urodynamics only a compensated underactive-like phenotype (increased void volume and decreased frequency but unchanged efficiency). Surprisingly, this phenotype was still present in the NLRP3-/- strain and so was not dependent on NLRP3 inflammasome-induced inflammation. To examine the cause of the compensated underactive-like phenotype, we assessed overall nerve bundle density and afferent nerve bundles (Aδ-fibers). Both were decreased in density during diabetes, but denervation was absent in the diabetic NLRP3-/- strain so it was deemed unlikely to cause the underactive-like symptoms. Changes in bladder smooth muscle contractility to cell depolarization and receptor activation were also not responsible as KCl (depolarizing agent), carbachol (muscarinic agonist), and α,β-methylene-ATP (purinergic agonist) elicited equivalent contractions in denuded bladder strips in all groups. However, electrical field stimulation revealed a diabetes-induced decrease in contractility that was not blocked in the NLRP3-/- strain, suggesting that the bladder compensated underactive-like phenotype in the male Akita mouse is likely through a decrease in efferent neurotransmitter release.NEW & NOTEWORTHY In this study, we show that diabetic bladder dysfunction (the most common diabetic complication) manifests through different mechanisms that may be related to severity of hyperglycemia and/or sex. Male Akita mice, which have severe hyperglycemia, develop bladder underactivity as a result of a decrease in efferent neurotransmitter release that is independent of inflammation. This contrasts with females, who have milder hyperglycemia, where diabetic bladder dysfunction progresses from overactivity to underactivity in an inflammation-dependent manner.
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Affiliation(s)
- Francis M Hughes
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Armand Allkanjari
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Michael R Odom
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Jack E Mulcrone
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Huixia Jin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
| | - J Todd Purves
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States
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Chakrabarty B, Bijos DA, Vahabi B, Clavica F, Kanai AJ, Pickering AE, Fry CH, Drake MJ. Modulation of Bladder Wall Micromotions Alters Intravesical Pressure Activity in the Isolated Bladder. Front Physiol 2019; 9:1937. [PMID: 30687132 PMCID: PMC6335571 DOI: 10.3389/fphys.2018.01937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022] Open
Abstract
Micromotions are phasic contractions of the bladder wall. During urine storage, such phasic activity has little effect on intravesical pressure, however, changed motile activity may underlie urodynamic observations such as detrusor overactivity. The potential for bladder motility to affect pressure reflects a summation of the overall movements, comprising the initiation, propagation, and dissipation components of micromotions. In this study, the influence of initiation of micromotions was investigated using calcium activated chloride channel blocker niflumic acid, and the effect of propagation using blockers of gap junctions. The overall bladder tone was modulated using isoprenaline. Isolated tissue strips and whole bladder preparations from juvenile rats were used. 18β-glycyrrhetinic acid was used to block gap junctions, reducing the amplitude and frequency of micromotions in in vitro and ex vivo preparations. Niflumic acid reduced the frequency of micromotions but had no effect on the amplitude of pressure fluctuations. Isoprenaline resulted in a reduction in pressure fluctuations and a decrease in pressure baseline. Using visual video data analysis, bladder movement was visible, irrespective of lack of pressure changes, which persisted during bladder relaxation. However, micromotions propagated over shorter distances and the overall bladder tone was reduced. All these results suggest that phasic activity of the bladder can be characterised by a combination of initiation and propagation of movement, and overall bladder tone. At any given moment, intravesical pressure recordings are an integration of these parameters. This synthesis gives insight into the limitations of clinical urodynamics, where intravesical pressure is the key indicator of detrusor activity.
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Affiliation(s)
- Basu Chakrabarty
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Dominika A Bijos
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
| | - Bahareh Vahabi
- Department of Applied Sciences, University of West England, Bristol, Bristol, United Kingdom
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
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Cullingsworth ZE, Kelly BB, Deebel NA, Colhoun AF, Nagle AS, Klausner AP, Speich JE. Automated quantification of low amplitude rhythmic contractions (LARC) during real-world urodynamics identifies a potential detrusor overactivity subgroup. PLoS One 2018; 13:e0201594. [PMID: 30110353 PMCID: PMC6093663 DOI: 10.1371/journal.pone.0201594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/18/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives Detrusor overactivity (DO) is characterized by non-voiding detrusor smooth muscle contractions during the bladder filling phase and often contributes to overactive bladder. In some patients DO is observed as isolated or sporadic contractions, while in others DO is manifested as low amplitude rhythmic contractions (LARC). The aim of this study was to develop an objective method to quantify LARC frequencies and amplitudes in urodynamic studies (UDS) and identify a subgroup DO of patients with LARC. Methods An automated Fast Fourier Transform (FFT) algorithm was developed to analyze a 205-second region of interest of retrospectively collected “real-world” UDS ending 30 seconds before voiding. The algorithm was designed to identify the three largest rhythmic amplitude peaks in vesical pressure (Pves) in the 1.75–6 cycle/minute frequency range. These peak Pves amplitudes were analyzed to determine whether they were 1) significant (above baseline Pves activity) and 2) independent (distinct from any in abdominal pressure (Pabd) rhythm). Results 95 UDS met criteria for inclusion and were analyzed with the FFT algorithm. During a blinded visual analysis, a neurourologist/urodynamicist identified 52/95 (55%) patients as having DO. The FFT algorithm identified significant and independent (S&I) LARC in 14/52 (27%) patients with DO and 0/43 patients (0%) without DO, resulting in 100% specificity and a significant association (Fischer’s exact test, p<0.0001). The average slowest S&I LARC frequency in this DO subgroup was 3.20±0.34 cycles/min with an amplitude of 8.40±1.30 cm-H2O. This algorithm can analyze individual UDS in under 5 seconds, allowing real-time interpretation. Conclusions An FFT algorithm can be applied to “real-world” UDS to automatically characterize the frequency and amplitude of underlying LARC. This algorithm identified a potential subgroup of DO patients with LARC.
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Affiliation(s)
- Zachary E. Cullingsworth
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University School of Engineering, Richmond, Virginia, United States of America
| | - Brooks B. Kelly
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Nicholas A. Deebel
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Andrew F. Colhoun
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Anna S. Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University School of Engineering, Richmond, Virginia, United States of America
| | - Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- Department of Surgery/Division of Urology Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, United States of America
| | - John E. Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University School of Engineering, Richmond, Virginia, United States of America
- * E-mail:
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Regional Structural and Functional Specializations in the Urethra of the Female Rat: Evidence for Complex Physiological Control Systems. Anat Rec (Hoboken) 2018; 301:1276-1289. [DOI: 10.1002/ar.23795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/22/2017] [Accepted: 11/30/2017] [Indexed: 12/11/2022]
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On the Site and Mechanism of Action of β 3-Adrenoceptor Agonists in the Bladder. Int Neurourol J 2017; 21:6-11. [PMID: 28361520 PMCID: PMC5380826 DOI: 10.5213/inj.1734850.425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/20/2022] Open
Abstract
The clinical success of mirabegron as the first β3-adrenoceptor (AR) agonist for treatment of the overactive bladder (OAB) syndrome, has resulted in substantial interest in its site and mechanism of action. Even if the adrenergic innervation of the bladder and urethra has been well studied, the location(s) of β3-ARs in different structures within the bladder wall and urethra, and the mode(s) of action of β3-AR stimulation have still not been established. The recent demonstration of β3-ARs on cholinergic nerve terminals with no immunoreactivity in urothelium or detrusor smooth muscle, is not in agreement with previous morphological studies, and functional data strongly suggest that β3-ARs can be found these structures. However, recent studies suggest that the β3-ARs on detrusor smooth muscle may not be the functionally most relevant. The assumption that β3-AR activation during bladder filling inhibits acetylcholine release from parasympathetic neurons by a prejunctional mechanism and that this decreases bladder micromotions that generate afferent activity, is an attractive hypothesis. It does not exclude that other mechanisms may be contributing, and supports combined approaches to reduce afferent activity for treatment of the OAB syndrome.
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Chapple CR, Siddiqui E. Mirabegron for the treatment of overactive bladder: a review of efficacy, safety and tolerability with a focus on male, elderly and antimuscarinic poor-responder populations, and patients with OAB in Asia. Expert Rev Clin Pharmacol 2017; 10:131-151. [DOI: 10.1080/17512433.2017.1275570] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Emad Siddiqui
- Global Medical Affairs, Astellas Pharma Europe Ltd, Chertsey, Surrey, UK
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Persyn S, Eastham J, De Wachter S, Gillespie J. Adrenergic signaling elements in the bladder wall of the adult rat. Auton Neurosci 2016; 201:40-48. [PMID: 27659399 DOI: 10.1016/j.autneu.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/04/2016] [Accepted: 09/09/2016] [Indexed: 01/25/2023]
Abstract
A growing body of work is describing the absence of a significant sympathetic innervation of the detrusor implying little sympathetic regulation of bladder contractility. However, low doses of adrenergic agonists are capable of relaxing the bladder smooth muscle. If these effects underpin a physiological response then the cellular nature and operation of this system are currently unknown. The present immunohistochemistry study was done to explore the existence of alternative adrenergic signaling elements in the rat bladder wall. Using antibodies to tyrosine hydroxylase (TH) and vesicular mono-amine transporter (vmat), few adrenergic nerves were found in the detrusor although TH immunoreactive (IR) nerves were apparent in the bladder neck. TH-IR and vmat-IR nerves were however abundant surrounding blood vessels. A population of vmat-IR cells was found within the network of interstitial cells that surround the detrusor muscle bundles. These vmat-IR cells were not or only weakly TH-IR. This suggests that these interstitial cells have the capacity to store and release catecholamines that may involve noradrenaline. Cells expressing the β1-adrenoceptor (β1AR-IR) were also detected within the interstitial cell network. Double staining with antibodies to β1AR and vmat suggests that the majority of vmat-IR interstitial cells show β1AR-IR indicative of an autocrine signaling system. In conclusion, a population of interstitial cells has the machinery to store, release and respond to catecholamines. Thus, there might exist a non-neuronal β-adrenergic system operating in the bladder wall possibly linked to one component of motor activity, micro-contractions, a system that may be involved in mechanisms underpinning bladder sensation.
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Affiliation(s)
- Sara Persyn
- Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
| | - Jane Eastham
- Uro-physiology Research Group, The Dental and Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, England.
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
| | - James Gillespie
- Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
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Drake MJ, Kanai A, Bijos DA, Ikeda Y, Zabbarova I, Vahabi B, Fry CH. The potential role of unregulated autonomous bladder micromotions in urinary storage and voiding dysfunction; overactive bladder and detrusor underactivity. BJU Int 2016; 119:22-29. [PMID: 27444952 DOI: 10.1111/bju.13598] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The isolated bladder shows autonomous micromotions, which increase with bladder distension, generate sensory nerve activity, and are altered in models of urinary dysfunction. Intravesical pressure resulting from autonomous activity putatively reflects three key variables; the extent of micromotion initiation, distances over which micromotions propagate, and overall bladder tone. In vivo, these variables are subordinate to the efferent drive of the central nervous system. In the micturition cycle storage phase, efferent inhibition keeps autonomous activity generally at a low level, where it may signal 'state of fullness', whilst maintaining compliance. In the voiding phase, mass efferent excitation elicits generalised contraction (global motility initiation). In lower urinary tract dysfunction, efferent control of the bladder can be impaired, for example due to peripheral 'patchy' denervation. In this case, loss of efferent inhibition may enable unregulated micromotility, and afferent stimulation, predisposing to urinary urgency. If denervation is relatively slight, the detrimental impact on voiding may be low, as the adjacent innervated areas may be able to initiate micromotility synchronous with the efferent nerve drive, so that even denervated areas can contribute to the voiding contraction. This would become increasingly inefficient the more severe the denervation, such that ability of triggered micromotility to propagate sufficiently to engage the denervated areas in voiding declines, so the voiding contraction increasingly develops the characteristics of underactivity. In summary, reduced peripheral coverage by the dual efferent innervation (inhibitory and excitatory) impairs regulation of micromotility initiation and propagation, potentially allowing emergence of overactive bladder and, with progression, detrusor underactivity.
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Affiliation(s)
- Marcus J Drake
- School of Clinical Sciences, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.,Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK
| | | | - Dominika A Bijos
- Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK
| | - Youko Ikeda
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bahareh Vahabi
- Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK.,School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Persyn S, De Wachter S, Wyndaele JJ, Eastham J, Gillespie J. The actions of isoprenaline and mirabegron in the isolated whole rat and guinea pig bladder. Auton Neurosci 2016; 198:19-27. [DOI: 10.1016/j.autneu.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 12/29/2022]
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Persyn S, Gillespie J, Eastham J, De Wachter S. Possible role of the major pelvic ganglion in the modulation of non-voiding activity in rats. Auton Neurosci 2016; 198:33-7. [PMID: 27346248 DOI: 10.1016/j.autneu.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/28/2016] [Accepted: 06/13/2016] [Indexed: 02/04/2023]
Abstract
AIMS The existence of a motor-sensory system contributing to bladder sensation is now becoming widely accepted. Although it is clear that the motor component of this system appears to be generated within the bladder wall, recent observations suggest that the mechanisms involved in its modulation may lie outside the wall. The present study was undertaken to gain more insights into the peripheral modulation of non-voiding activity and the role of the major pelvic ganglion. METHODS Male Sprague-Dawley rats anesthetized with urethane were used. The bladder was filled till 60% of the micturition threshold volume. The baseline pressure and the superimposed non-voiding activity were observed before and after consecutive bilateral transections of the hypogastric and pelvic nerves and bilateral ablation of the major pelvic ganglia. RESULTS Hypogastric and pelvic nerve transection didn't significantly change the baseline pressure and superimposed non-voiding activity. Removal of the major pelvic ganglia resulted into an increased baseline pressure when compared with the control and increased amplitude of the non-voiding contractions when compared with both the decentralized condition (both hypogastric and pelvic nerves transected) and the control. The frequency of the non-voiding contractions wasn't affected. CONCLUSIONS Non-voiding activity during the urine storage phase seems to be modulated at the level of the major pelvic ganglion. This suggests the possibility of local circuits between the bladder and the peripheral ganglia that may be responsible for an inhibitory component influencing non-voiding activity.
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Affiliation(s)
- Sara Persyn
- Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
| | - James Gillespie
- Uro-physiology Research Group, The Dental and Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, England.
| | - Jane Eastham
- Uro-physiology Research Group, The Dental and Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, England.
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
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Propping S, Lorenz K, Michel MC, Wirth MP, Ravens U. β-Adrenoceptor-mediated Relaxation of Urinary Bladder Muscle in β2-Adrenoceptor Knockout Mice. Front Pharmacol 2016; 7:118. [PMID: 27242525 PMCID: PMC4860462 DOI: 10.3389/fphar.2016.00118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: In order to characterize the β-adrenoceptor (AR) subtypes involved in agonist-stimulated relaxation of murine urinary bladder we studied the effects of (-)-isoprenaline and CL 316,243 on tonic contraction and spontaneous contractions in detrusor strips of wild-type (WT) and β2-AR knockout (β2-AR KO) mice. Materials and Methods: Urinary bladders were isolated from male WT and β2-AR KO mice. β-AR subtype expression was determined with quantitative real-time PCR. Intact muscle strips pre-contracted with KCl (40 mM) were exposed to cumulatively increasing concentrations of (-)-isoprenaline or β3-AR agonist CL 316,243 in the presence and absence of the subtype-selective β-AR blockers CGP 20712A (β1-ARs), ICI 118,551 (β2-ARs), and L748,337 (β3-ARs). Results: Quantitative real-time PCR confirmed lack of β2-AR expression in bladder tissue from β2-AR KO mice. In isolated detrusor strips, pre-contraction with KCl increased basal tone and enhanced spontaneous activity significantly more in β2-AR KO than in WT. (-)-Isoprenaline relaxed tonic tension and attenuated spontaneous activity with similar potency, but the concentrations required were two orders of magnitude higher in β2-AR KO than WT. The concentration-response curves (CRCs) for relaxation were not affected by CGP 20712A (300 nM), but were shifted to the right by ICI 118,551 (50 nM) and L748,337 (10 μM). The -logEC50 values for (-)-isoprenaline in WT and β2-AR KO tissue were 7.98 and 6.00, respectively, suggesting a large receptor reserve of β2-AR. (-)-CL 316,243 relaxed detrusor and attenuated spontaneous contractions from WT and β2-AR KO mice with a potency corresponding to the drug’s affinity for β3-AR. L743,337 shifted the CRCs to the right. Conclusion: Our findings in β2-AR KO mice suggest that there is a large receptor reserve for β2-AR in WT mice so that this β-AR subtype will mediate relaxation of tone and attenuation of spontaneous activity under physiological conditions. Nevertheless, upon removal of this reserve, β3-AR can also mediate murine detrusor relaxation.
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Affiliation(s)
- Stefan Propping
- Department of Urology, Faculty of Medicine Carl Gustav Carus, Dresden University of TechnologyDresden, Germany; Department of Physiology, Faculty of Medicine Carl Gustav Carus, Dresden University of TechnologyDresden, Germany
| | - Kristina Lorenz
- Department of Pharmacology and Toxicology, Julius Maximilian University WürzburgWürzburg, Germany; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V.Dortmund, Germany; West German Heart and Vascular Center Essen, University Hospital Essen-DuisburgDuisburg, Germany
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University Mainz, Germany
| | - Manfred P Wirth
- Department of Urology, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology Dresden, Germany
| | - Ursula Ravens
- Department of Physiology, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology Dresden, Germany
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Michel MC, Korstanje C. β3-Adrenoceptor agonists for overactive bladder syndrome: Role of translational pharmacology in a repositioning clinical drug development project. Pharmacol Ther 2016; 159:66-82. [PMID: 26808167 DOI: 10.1016/j.pharmthera.2016.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
β3-Adrenoceptor agonists were originally considered as a promising drug class for the treatment of obesity and/or type 2 diabetes. When these development efforts failed, they were repositioned for the treatment of the overactive bladder syndrome. Based on the example of the β3-adrenoceptor agonist mirabegron, but also taking into consideration evidence obtained with ritobegron and solabegron, we discuss challenges facing a translational pharmacology program accompanying clinical drug development for a first-in-class molecule. Challenges included generic ones such as ligand selectivity, species differences and drug target gene polymorphisms. Challenges that are more specific included changing concepts of the underlying pathophysiology of the target condition while clinical development was under way; moreover, a paucity of public domain tools for the study of the drug target and aspects of receptor agonists as drugs had to be addressed. Nonetheless, a successful first-in-class launch was accomplished. Looking back at this translational pharmacology program, we conclude that a specifically tailored and highly flexible approach is required. However, several of the lessons learned may also be applicable to translational pharmacology programs in other indications.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany.
| | - Cees Korstanje
- Department of Drug Discovery Science & Management-Europe, Astellas Pharma Europe R&D, Leiden, The Netherlands
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13
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Andersson KE. Drug therapy of overactive bladder--what is coming next? Korean J Urol 2015; 56:673-9. [PMID: 26495067 PMCID: PMC4610893 DOI: 10.4111/kju.2015.56.10.673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/03/2015] [Indexed: 01/25/2023] Open
Abstract
After the approval and introduction of mirabegron, tadalafil, and botulinum toxin A for treatment of lower urinary tract symptoms/overactive bladder, focus of interest has been on their place in therapy versus the previous gold standard, antimuscarinics. However, since these agents also have limitations there has been increasing interest in what is coming next - what is in the pipeline? Despite progress in our knowledge of different factors involved in both peripheral and central modulation of lower urinary tract dysfunction, there are few innovations in the pipe-line. Most developments concern modifications of existing principles (antimuscarinics, β3-receptor agonists, botulinum toxin A). However, there are several new and old targets/drugs of potential interest for further development, such as the purinergic and cannabinoid systems and the different members of the transient receptor potential channel family. However, even if there seems to be good rationale for further development of these principles, further exploration of their involvement in lower urinary tract function/dysfunction is necessary.
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Affiliation(s)
- Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA. ; Aarhus Institute for Advanced Sciences, Aarhus University, Aarhus, Denmark
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Gillespie J.I, Rouget C, Palea S, Granato C, Korstanje C. Beta adrenergic modulation of spontaneous microcontractions and electrical field-stimulated contractions in isolated strips of rat urinary bladder from normal animals and animals with partial bladder outflow obstruction. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:719-26. [DOI: 10.1007/s00210-015-1136-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 05/20/2015] [Indexed: 01/20/2023]
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15
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The actions of prolonged exposure to cholinergic agonists on isolated bladder strips from the rat. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:737-47. [DOI: 10.1007/s00210-015-1129-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/03/2015] [Indexed: 01/05/2023]
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16
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The expression of β3-adrenoceptor and muscarinic type 3 receptor immuno-reactivity in the major pelvic ganglion of the rat. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:695-708. [DOI: 10.1007/s00210-015-1122-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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