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Wu SY, Hsu CK, Lim LY, Chen YC, Chang HH, Yang SSD. Ketamine Inhalation Alters Behavior and Lower Urinary Tract Function in Mice. Biomedicines 2022; 11:biomedicines11010075. [PMID: 36672583 PMCID: PMC9855675 DOI: 10.3390/biomedicines11010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
We aimed to evaluate behavioral and lower urinary tract changes in mice using a novel ketamine inhalation model mimicking human ketamine abusers and compare the results to those obtained using a ketamine intraperitoneal injection model. C57BL/6N mice were placed in a transparent acrylic observation cage connected to an ultrasonic nebulizer producing ketamine (KI) or saline (SI) fog. The mice were given KI or SI fog twice a week for three months. In another experiment arm, the mice were given intraperitoneal ketamine injections (KP) or saline injections (SP) twice a week for three months. The presence of urine ketamine (>100 ng/mL) was determined using a quick test kit. Locomotor activity was recorded by video using the open field test. Lower urinary tract function was assessed using urine spots, cystometry and histology. KI and KP mice crossed the center more frequently and traveled farther than SI and SP mice. Only KI mice, however, demonstrated popcorn-like jumping, and frequent center crossing. Detrusor overactivity, reduced cystometric bladder capacity, and denuded mucosa were observed in both KI and KP mice. Ketamine inhalation induces behavioral and lower urinary tract changes in mice that are comparable to intraperitoneal ketamine injections.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Kai Hsu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Li-Yi Lim
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Surgery, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur 56000, Malaysia
| | - Yi-Chyan Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
| | - Hsi-Hsien Chang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-266289779
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Castellani D, Pirola GM, Gubbiotti M, Rubilotta E, Gudaru K, Gregori A, Dellabella M. What urologists need to know about ketamine-induced uropathy: A systematic review. Neurourol Urodyn 2020; 39:1049-1062. [PMID: 32212278 DOI: 10.1002/nau.24341] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Abstract
AIMS Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamine-induced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments. METHODS We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted. RESULTS A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine/ions in the bladder wall result in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokines-cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin-A were helpful in patients with early-stage KIU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty. CONCLUSIONS KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis.
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Affiliation(s)
| | - Giacomo M Pirola
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Marilena Gubbiotti
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Kalyan Gudaru
- Department of Urology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli Sacco, Milan, Italy
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Yang SS, Chang H, Chang S. Does ketamine ameliorate the social stress‐related bladder dysfunction in mice? Neurourol Urodyn 2020; 39:935-944. [DOI: 10.1002/nau.24324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Stephen Shei‐Dei Yang
- Division of Urology, Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei Taiwan
- School of MedicineBuddhist Tzu Chi UniversityHualien Taiwan
| | - Hsi‐Hsien Chang
- Division of Urology, Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei Taiwan
| | - Shang‐Jen Chang
- Division of Urology, Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationNew Taipei Taiwan
- School of MedicineBuddhist Tzu Chi UniversityHualien Taiwan
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How Ketamine Affects Livers of Pregnant Mice and Developing Mice? Int J Mol Sci 2017; 18:ijms18051098. [PMID: 28534828 PMCID: PMC5455006 DOI: 10.3390/ijms18051098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 12/28/2022] Open
Abstract
It is well known that ketamine abuse can induce liver damage in adult addicts, but the effects of ketamine abuse in pregnant mothers on their offspring have received less attention. In this study, we investigated the effects of 5-day ketamine injections (30 mg/kg) to pregnant Institute for Cancer Research (ICR) mice during early gestation or mid-gestation on the aspartate aminotransferase (AST) and alkaline phosphatase (ALP) activities of the mothers and the offspring. We also looked into whether administering ketamine treatment to the mothers had any effects on the extent of fibrosis, cell proliferation and cell death in the livers of the newborns. No significant biochemical differences were found between treatment and control groups in the mothers. In the offspring, ketamine treatment mildly suppressed the gradual increase of hepatic AST activity in neonates during liver maturation. Measurements of hepatic ALP activity and lactic acid dehydrogenase (LDH) immunoreactivity revealed that ketamine treatment may lead to increased cell death. Proliferation of liver cells of the newborns was also retarded as shown by reduced proliferative cell nuclear antigen (PCNA) immunoreactivity in the ketamine groups. No obvious fibrosis was evident. Thus, we demonstrated that ketamine administration to pregnant mice suppressed hepatic development and also induced liver cell death of the offspring.
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Lin CC, Yang AH, Lin ATL. Activation of the mTOR dependent signaling pathway underlies ketamine-induced uropathy. Neurourol Urodyn 2017; 36:1988-1995. [PMID: 28220552 DOI: 10.1002/nau.23234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/16/2016] [Accepted: 01/20/2017] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the pathogenic role of activation of the mammalian target of the rapamycin (mTOR) in the ketamine induced microvascular injury. METHODS Twenty-three patients with ketamine-induced cystitis (KC) and 16 control volunteers were recruited. Bladder tissues were obtained from both groups by cystoscopic biopsies. Phospho-S6 ribosomal protein (p-S6RP), an end product of the mTOR pathway, was stained in the urinary bladder from both groups. Endothelial cells of the urinary bladder (HBdMECs) were examined to investigate the in vitro activation of the mTOR pathway and the co-expression of the endothelial marker (cluster of differentiation 31 [CD31]) and the mesenchymal marker (fibroblast-specific protein 1 [FSP-1]). RESULTS Expression of p-S6RP increased significantly after ketamine exposure, especially in the vesical microvessels of KC patients. In HBdMECs treated with 100 µM Ketamine, time-dependent activation of the mTOR pathway occurred, with significantly increased levels of the phosphorylated forms of mTOR at 30 min and of S6RP and p70S6 kinase (p70S6K) at 6 h. The increased level of p-S6RP returned to baseline within 2 days after ketamine exposure. The co-expression of CD31 and FSP-1 implied that EndMT was present in HBdMECs at 7 days after ketamine treatment, while TGF-β1 facilitated significant up-regulation of FSP-1 at 1 day after treatment. Furthermore, when the mTOR inhibitor rapamycin was administered with ketamine to the HBdMECs, the expression of FSP-1 decreased significantly. CONCLUSIONS Ketamine induces activation of the mTOR pathway and subsequent mesenchymal phenotypic expression (FSP1) in HBdMECs.
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Affiliation(s)
- Chih-Chieh Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Hang Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pathology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Alex Tong-Long Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
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Lin CC, Lin ATL, Yang AH, Chen KK. Microvascular Injury in Ketamine-Induced Bladder Dysfunction. PLoS One 2016; 11:e0160578. [PMID: 27529746 PMCID: PMC4987039 DOI: 10.1371/journal.pone.0160578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
The pathogenesis of ketamine-induced cystitis (KC) remains unclear. In this study, bladder microvascular injury was investigated as a possible contributing mechanism. A total of 36 KC patients with exposure to ketamine for more than 6 months, and 9 control subjects, were prospectively recruited. All participants completed questionnaires, including the O'Leary-Sant interstitial cystitis symptom index (ICSI) and the interstitial cystitis problem index (ICPI). All KC patients received a urodynamic study and radiological exams. Bladder tissues were obtained from cystoscopic biopsies in the control group and after hydrodistention in the KC group. Double-immunofluorescence staining of N-methyl-d-aspartate receptor subunit 1 (NMDAR1) and the endothelial marker, cluster of differentiation 31 (CD31), was performed to reveal the existence of NMDAR1 on the endothelium. Electron microscopy (EM) was applied to assess the microvascular change in the urinary bladder and to measure the thickening of the basement membrane (BM). A proximity ligation assay (PLA) was used to quantify the co-localization of the endothelial CD31 receptor and the mesenchymal marker [fibroblast-specific protein 1 (FSP-1)]. The Mann-Whitney U test and Spearman's correlation coefficient were used for statistical analysis. The mean ICSI [14.38 (± 4.16)] and ICPI [12.67 (± 3.54)] scores of the KC group were significantly higher than those (0 and 0, respectively) of the control group (both p < 0.001). The KC patients had decreasing cystometric bladder capacity (CBC) with a mean volume of 65.38 (± 48.67) mL. NMDAR1 was expressed on endothelial cells in both groups under immunofluorescence staining. Moreover, KC patients had significant BM duplication of microvessels in the mucosa of the urinary bladder under EM. The co-expression of the endothelial marker CD31 and mesenchymal marker FSP1 was significantly stained and calculated under PLA. In conclusion, microvascular injury and mesenchymal phenotypic alteration of endothelial cells can potentially contribute to KC-induced bladder dysfunction.
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Affiliation(s)
- Chih-Chieh Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Alex Tong-Long Lin
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Hang Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pathology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Kuang-Kuo Chen
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
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Tang HC, Lam WP, Zhang X, Leung PC, Yew DT, Liang W. Short-Term Flavoxate Treatment Alters Detrusor Contractility Characteristics: Renewed Interest in Clinical Use? Low Urin Tract Symptoms 2015; 7:149-54. [PMID: 26663730 DOI: 10.1111/luts.12063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Flavoxate has had a long history of use in the treatment of overactive bladder, despite the lack of documentation on its clinical efficacy and mechanism(s) of action. This study was conducted to understand how contractility characteristics of the detrusor are affected after a short period of flavoxate treatment. METHODS Eight-week-old mice were treated with flavoxate for 5 days and detrusor contractile responses were examined ex vivo under different pharmacological and electrical stimuli. RESULTS K(+) -Krebs'-induced contraction developed more slowly while 64 Hz electrical field stimulation-induced contraction developed faster in flavoxate-treated strips when compared to control. Amplitudes of maximal and steady-state contraction induced by 3 µmol/L carbachol were also larger after flavoxate treatment. Control strips showed an overall greater dependence on stimulus strength in eliciting the responses. CONCLUSIONS These findings provided new information of how short-term flavoxate treatment altered contractility characteristics at the bladder level, which may instill new interest in investigating the use of this drug in bladder disorders not responding well to conventional treatments.
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Affiliation(s)
- Hong C Tang
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai P Lam
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin Zhang
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping C Leung
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Phytochemistry and Plant Resources in West China (Partner Laboratory in the Chinese University of Hong Kong), Hong Kong, China
| | - David T Yew
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Willmann Liang
- Pharmacology Unit, Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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