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Ganguly A, Tyagi S, Chermansky C, Kanai A, Beckel J, Hashimoto M, Cho KJ, Chancellor M, Kaufman J, Yoshimura N, Tyagi P. Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options. Drugs Aging 2023; 40:241-261. [PMID: 36879156 PMCID: PMC11167658 DOI: 10.1007/s40266-023-01009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/08/2023]
Abstract
This article provides an overview of the diagnosis and the treatment of lower urinary tract symptoms in older adults complicated by the neurodegenerative changes in the micturition reflex and further confounded by age-related decline in hepatic and renal clearance raising the propensity of adverse drug reactions. The first-line drug treatment for lower urinary tract symptoms, orally administered antimuscarinics, fails to reach the equilibrium dissociation constant of muscarinic receptors even at their maximum plasma concentration and tends to evoke a half-maximal response at a muscarinic receptor occupancy of just 0.206% in the bladder with a minimal difference from exocrine glands, which raises the adverse drug reaction risk. On the contrary, intravesical antimuscarinics are instilled at concentrations 1000-fold higher than the oral maximum plasma concentration and the equilibrium dissociation constant erects a downhill concentration gradient that drives passive diffusion and achieves a mucosal concentration around ten-fold lower than the instilled concentration for a long-lasting occupation of muscarinic receptors in mucosa and sensory nerves. A high local concentration of antimuscarinics in the bladder triggers alternative mechanisms of action and is supposed to engage retrograde transport to nerve cell bodies for neuroplastic changes that underlie a long-lasting therapeutic effect, while an intrinsically lower systemic uptake of the intravesical route lowers the muscarinic receptor occupancy of exocrine glands to lower the adverse drug reaction relative to the oral route. Thus, the traditional pharmacokinetics and pharmacodynamics of oral treatment are upended by intravesical antimuscarinics to generate a dramatic improvement (~ 76%) noted in a meta-analysis of studies enrolling children with neurogenic lower urinary tract symptoms on the primary endpoint of maximum cystometric bladder capacity as well as the secondary endpoints of filling compliance and uninhibited detrusor contractions. The therapeutic success of intravesical multidose oxybutynin solution or oxybutynin entrapped in the polymer for sustained release in the pediatric population bodes well for patients with lower urinary tract symptoms at the other extreme of the age spectrum. Though generally used to predict oral drug absorption, Lipinski's rule of five can also explain the ten-fold lower systemic uptake from the bladder of positively charged trospium over oxybutynin, a tertiary amine. Chemodenervation by an intradetrusor injection of onabotulinumtoxinA is merited for patients with idiopathic overactive bladder discontinuing oral treatment because of a lack of efficacy. However, age-related peripheral neurodegeneration potentiates the adverse drug reaction risk of urinary retention that motivates the quest of liquid instillation, delivering larger fraction of onabotulinumtoxinA to the mucosa as opposed to muscle by an intradetrusor injection can also probe the neurogenic and myogenic predominance of idiopathic overactive bladder. Overall, the treatment paradigm of lower urinary tract symptoms in older adults should be tailored to individual's overall health status and the risk tolerance for adverse drug reactions.
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Affiliation(s)
- Anirban Ganguly
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Shachi Tyagi
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Christopher Chermansky
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Anthony Kanai
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Jonathan Beckel
- Department of Pharmacology, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Mamoru Hashimoto
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Kang Jun Cho
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | | | | | - Naoki Yoshimura
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Pradeep Tyagi
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA.
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Yu W. Reviving Cav1.2 as an attractive drug target to treat bladder dysfunction. FASEB J 2022; 36:e22118. [PMID: 34939692 PMCID: PMC9841550 DOI: 10.1096/fj.202101475r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023]
Abstract
Inhibition of bladder contraction with antimuscarinics is a common approach to treat bladder hyperactivity, and the L-type voltage-gated calcium channel α1C (Cav1.2) is crucial for bladder contractility. Therefore, strategies aimed at inhibiting Cav1.2 appear warranted. However, multiple clinical trials that attempted to treat bladder overactivity with calcium channel blockers (CCBs) have been unsuccessful, creating an unsolved mystery. In contrast, cardiologists and epidemiologists have reported strong associations between CCB use and bladder hyperactivity, opposing expectations of urologists. Recent findings from our lab offer a potential explanation. We have demonstrated that ketamine which can cause cystitis, functions, like nifedipine, as a Cav1.2 antagonist. We also show that a Cav1.2 agonist which potentiates muscle contraction, rather than antagonizing it, can increase the volume of voids and reduce voiding frequency. This perspective will discuss in detail the unsuccessful urological trials of CCBs and the promise of Cav1.2 agonists as potential novel therapies for bladder dysfunctions.
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Affiliation(s)
- Weiqun Yu
- Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachuesetts USA
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Elbaset M, Taha DE, El-Hefnawy AS, Zahran MH, Shokeir A. Assessment of Anticholinergic Use After Fading of BTX-A Effects in Refractory Idiopathic Overactive Bladder: A Prospective Blinded Randomized Trial. Int Neurourol J 2019; 23:240-248. [PMID: 31607104 PMCID: PMC6790821 DOI: 10.5213/inj.1938098.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of re-treatment with anticholinergics on refractory idiopathic overactive bladder (OAB) previously treated with intravesical botulinum neurotoxin type A (BTX-A) injections. METHODS One hundred patients were initially managed by intravesical injections of 100 IU of BTX-A. After the effects of BTX-A faded, patients were randomized into 2 groups: group A patients received solifenacin (10 mg) for 12 weeks (study group), while group B patients received placebo treatment for 12 weeks (control group), then subsequently received solifenacin (10 mg) for another 6 weeks. All patients underwent preoperative urodynamic testing. Patients were asked to complete the validated overactive bladder symptoms score (OABSS) and incontinence quality of life (I-QoL) instruments after the effects of intravesical BTX-A faded and at 12 weeks of follow-up. Univariate and multivariate analyses of the factors affecting treatment response were conducted. RESULTS At 12 weeks of follow-up, in group A, all OABSS items, including the total score, had improved significantly (P<0.0001). Group A had lower frequency and amplitude of detrusor overactivity and detrusor leak point pressure (P<0.0001, P=0.03, and P=0.01, respectively). Cystometric capacity also increased significantly (P=0.007), as did all I-QoL parameters. In a comparison of patients with failed treatment and patients with successful treatment, female sex, repeated intravesical BTX-A injections, and increased bladder capacity were statistically significant (P=0.001, P=0.0001, and P=0.002, respectively). Repeated intravesical BTX-A injections and increased bladder capacity were independent factors predicting treatment success. CONCLUSION In patients with refractory idiopathic OAB, reuse of anticholinergics could be an effective treatment option in patients after the effects of BTX-A fade. Repeated intravesical BTX-A injections and increased cystometric capacity could affect treatment response.
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Affiliation(s)
- M.A. Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Diaa-Eldin Taha
- Urology Department, KafrELshiekh University, KafrELshiekh, Egypt
| | - Ahmed S. El-Hefnawy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamad H. Zahran
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A.A Shokeir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Hao Y, Wang L, Chen H, Hill WG, Robson SC, Zeidel ML, Yu W. Targetable purinergic receptors P2Y12 and A2b antagonistically regulate bladder function. JCI Insight 2019; 4:122112. [PMID: 31434806 DOI: 10.1172/jci.insight.122112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Abnormalities in purine availability or purinergic receptor density are commonly seen in patients with lower urinary tract symptoms (LUTS), but the underlying mechanisms relating altered receptor function to LUTS are unknown. Here we provide extensive evidence for the reciprocal interplay of multiple receptors responding to ATP, ADP (adenosine diphosphate), and adenosine, agonists that regulate bladder function significantly. ADP stimulated P2Y12 receptors, causing bladder smooth muscle (BSM) contraction, whereas adenosine signaling through potentially newly defined A2b receptors, actively inhibited BSM purinergic contractility. The modulation of adenylyl cyclase-cAMP signaling via A2b and P2Y12 interaction actively regulated bladder contractility by modulating intracellular calcium levels. KO mice lacking the receptors display diametrically opposed bladder phenotypes, with P2Y12-KO mice exhibiting an underactive bladder (UAB) phenotype with increased bladder capacity and reduced voiding frequency, whereas A2b-KO mice have an overactive bladder (OAB), with decreased capacity and increased voiding frequency. The opposing phenotypes in P2Y12-KO and A2b-KO mice not only resulted from dysregulated BSM contractility, but also from abnormal BSM cell growth. Finally, we demonstrate that i.p. administration of drugs targeting P2Y12 or A2b receptor rescues these abnormal phenotypes in both KO mice. These findings strongly indicate that P2Y12 and A2b receptors are attractive therapeutic targets for human patients with LUTS.
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Affiliation(s)
- Yuan Hao
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Lu Wang
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Chongqing University, Chongqing, China
| | - Huan Chen
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren G Hill
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Simon C Robson
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark L Zeidel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Weiqun Yu
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Shang Z, Jia C, Yan H, Cui B, Wu J, Wang Q, Gao W, Cui X, Li J, Ou T. Injecting RNA interference lentiviruses targeting the muscarinic 3 receptor gene into the bladder wall inhibits neurogenic detrusor overactivity in rats with spinal cord injury. Neurourol Urodyn 2018; 38:615-624. [DOI: 10.1002/nau.23894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Zhenhua Shang
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Chunsong Jia
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Hao Yan
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Bo Cui
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Jiangtao Wu
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Qi Wang
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Wei Gao
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Xin Cui
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Jin Li
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Tongwen Ou
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
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Deruyver Y, Weyne E, Dewulf K, Rietjens R, Pinto S, Van Ranst N, Franken J, Vanneste M, Albersen M, Gevaert T, Vennekens R, De Ridder D, Voets T, Everaerts W. Intravesical Activation of the Cation Channel TRPV4 Improves Bladder Function in a Rat Model for Detrusor Underactivity. Eur Urol 2018; 74:336-345. [PMID: 29875065 DOI: 10.1016/j.eururo.2018.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Improvement of bladder emptying by modulating afferent nerve activity is an attractive therapeutic strategy for detrusor underactivity. Transient receptor potential vanilloid 4 (TRPV4) is a sensory ion channel in urothelial cells that contribute to the detection of bladder filling. OBJECTIVE To investigate the potential benefit of intravesical TRPV4 agonists in a pelvic nerve injury rat model for detrusor underactivity. DESIGN, SETTING, AND PARTICIPANTS Female wild-type and Trpv4 knockout rats underwent sham surgery or bilateral pelvic nerve injury (bPNI). Four weeks later, rats underwent cystometry with infusion of the TRPV4 agonist GSK1016790A. Bladders were harvested for in vitro pharmacological studies, quantitative reverse polymerase chain reaction and immunohistochemistry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Data are expressed as median ± interquartile range. Statistical comparisons were made using the Mann-Witney U test and Wilcoxon signed rank test as appropriate. RESULTS AND LIMITATIONS Rats with bPNI showed a phenotype characteristic of detrusor underactivity with lower-amplitude voiding contractions, decreased voiding frequency, and increased postvoid residual. Intravesical application of GSK1016790A increased voiding frequency and reduced postvoid residual in wild-type, but not Trpv4-/-, rats. In isolated bladder strips, GSK1016790A did not induce relevant contractions, indicating that the observed improvements in bladder function are the result of increased afferent signalling through TRPV4 activation, rather than a local effect on the detrusor. The altered urinary phenotype of Trpv4-/- mice was not apparent in the Trpv4-/- rat model, suggesting species-related functional variations. Our results are limited to the preclinical setting in rodents. CONCLUSIONS Intravesical activation of TRPV4 improves bladder dysfunction after bPNI by increasing afferent signalling. PATIENT SUMMARY We demonstrate that the sensory protein transient receptor potential vanilloid 4 (TRPV4) can be targeted to improve bladder function in animals that have iatrogenic injury to the nerves innervating the bladder. Further research is required to determine whether these results can be translated to patients with an underactive bladder.
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Affiliation(s)
- Yves Deruyver
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium
| | - Emmanuel Weyne
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Dewulf
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Roma Rietjens
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium
| | - Silvia Pinto
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium; VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Nele Van Ranst
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium; VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Jan Franken
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium
| | - Matthias Vanneste
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium; VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Gevaert
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Rudi Vennekens
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium; VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium
| | - Thomas Voets
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium; VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Wouter Everaerts
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; TRP Channel Research Platform Leuven (TRPLe), KU Leuven, Leuven, Belgium.
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West EG, Lang R, Sellers D, Chess-Williams R, McDermott C. Ibuprofen Decreases Spontaneous Activity and Enhances Nerve-Evoked Contractions to Minimize Mitomycin C-Induced Bladder Dysfunction. J Pharmacol Exp Ther 2018; 366:282-290. [PMID: 29784662 DOI: 10.1124/jpet.118.248989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022] Open
Abstract
Inflammation may play a causal role in urological side effects reported following intravesical mitomycin C (MMC). Our aim was to investigate the effects of the nonsteroidal anti-inflammatory drug ibuprofen (IBU) on the cytotoxic potency of MMC and the potential for IBU to protect against bladder dysfunction. Malignant (RT4, T24) and normal (UROtsa) urothelial lines were treated with MMC followed by ibuprofen, with cell viability and caspase-3 activity assessed. Female C57BL/6JArc mice (Saline/Control, MMC, Saline + IBU, and MMC + IBU) received intravesical treatment (1 hour) with saline or MMC (2 mg/ml), with IBU (1 mg/ml) delivered in drinking water (for 7 days). Voiding pattern analysis was conducted prior to and following (1, 3, 7 days) treatment. A whole-bladder preparation was used to assess compliance, contractile responses, and urothelial-mediator release. Ibuprofen selectively increased the cytotoxic potency of MMC and caspase-3 activity in both malignant cells lines but not in UROtsa. MMC significantly increased voiding frequency at 24 hours and 3 days, whereas administration of ibuprofen significantly reduced this effect. MMC significantly increased the frequency of spontaneous contractions from 2.3 ± 0.5 contractions/min in saline controls to 4.8 ± 0.16 contractions/min, with ibuprofen protecting against this change. Interestingly, although nerve-evoked responses were not altered by MMC, they were increased in both IBU groups. Ibuprofen improved voiding dysfunction following MMC treatment by reducing spontaneous phasic activity and enhancing nerve-mediated contractions. Ibuprofen use in bladder cancer patients may help to minimize the urological adverse effects associated with intravesical MMC.
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Affiliation(s)
- Eliza G West
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Ryan Lang
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Donna Sellers
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Catherine McDermott
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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Acute radiation impacts contractility of guinea-pig bladder strips affecting mucosal-detrusor interactions. PLoS One 2018. [PMID: 29513744 PMCID: PMC5841802 DOI: 10.1371/journal.pone.0193923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Radiation-induced bladder toxicity is associated with radiation therapy for pelvic malignancies, arising from unavoidable irradiation of neighbouring normal bladder tissue. This study aimed to investigate the acute impact of ionizing radiation on the contractility of bladder strips and identify the radiation-sensitivity of the mucosa vs the detrusor. Guinea-pig bladder strips (intact or mucosa-free) received ex vivo sham or 20Gy irradiation and were studied with in vitro myography, electrical field stimulation and Ca2+-fluorescence imaging. Frequency-dependent, neurogenic contractions in intact strips were reduced by irradiation across the force-frequency graph. The radiation-difference persisted in atropine (1μM); subsequent addition of PPADs (100μM) blocked the radiation effect at higher stimulation frequencies and decreased the force-frequency plot. Conversely, neurogenic contractions in mucosa-free strips were radiation-insensitive. Radiation did not affect agonist-evoked contractions (1μM carbachol, 5mM ATP) in intact or mucosa-free strips. Interestingly, agonist-evoked contractions were larger in irradiated mucosa-free strips vs irradiated intact strips suggesting that radiation may have unmasked an inhibitory mucosal element. Spontaneous activity was larger in control intact vs mucosa-free preparations; this difference was absent in irradiated strips. Spontaneous Ca2+-transients in smooth muscle cells within tissue preparations were reduced by radiation. Radiation affected neurogenic and agonist-evoked bladder contractions and also reduced Ca2+-signalling events in smooth muscle cells when the mucosal layer was present. Radiation eliminated a positive modulatory effect on spontaneous activity by the mucosa layer. Overall, the findings suggest that radiation impairs contractility via mucosal regulatory mechanisms independent of the development of radiation cystitis.
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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Biardeau X, Przydacz M, Aharony S, Loutochin G, Campeau L, Kyheng M, Corcos J. Early Fesoterodine Fumarate Administration Prevents Neurogenic Detrusor Overactivity in a Spinal Cord Transected Rat Model. PLoS One 2017; 12:e0169694. [PMID: 28060912 PMCID: PMC5217950 DOI: 10.1371/journal.pone.0169694] [Citation(s) in RCA: 4] [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: 08/22/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background In spinal cord injury, onset of detrusor overactivity (DO) is detrimental for quality of life (incontinence) and renal risk. Prevention has only been achieved with complex sophisticated electrical neuromodulation techniques. Purpose To assess the efficacy of early fesoterodine fumarate (FF) administration in preventing bladder overactivity in a spinal cord transected (SCT) rat model. Methods 33 Sprague-Dawley rats were allocated to 6 groups–Group 1: 3 normal controls; Group 2: 6 SCT controls; Group 3: 6 SCT rats + FF 0.18 mg/kg/d; Group 4: 6 SCT rats + FF 0.12 mg/kg/d; Group 5: 6 SCT rats + FF 0.18 mg/kg/d + 72-h wash-out period; Group 6: 6 SCT rats + FF 0.12 mg/kg/d + 72-h wash-out period. SCT was performed at T10. FF was continuously administered. Cystometry was undertaken 6 weeks after SCT in awake rats recording intermicturition pressure (IMP), baseline pressure, threshold pressure (Pthres) and maximum pressure (Pmax). Normal controls and SCT controls were initially compared using the Mann-Whitney U tests in order to confirm the SCT effect on cystometric parameters. The comparisons in cystometric and metabolic cage parameters between SCT controls and treated rats were done using post-hoc Dunn’s tests for Kruskal-Wallis analysis. Statistical testing was conducted at the two-tailed α-level of 0.05. Results Pressure parameters were significantly higher in SCT control group compared to normal controls. Six weeks after SCT, IMP was significantly lower in low dose treated group than in SCT controls. Pmax was significantly lower in 3 treated groups compared to SCT controls. Pthres was significantly lower in full time treated groups than in SCT controls. Conclusion Early administration of FF modulates bladder overactivity in a SCT rat model. Whereas short-term prevention has been demonstrated, the long-term should be further analyzed. Clinical application of these results should confirm this finding through randomized research protocols.
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Affiliation(s)
- Xavier Biardeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shachar Aharony
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - George Loutochin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Maeva Kyheng
- Department of Biostatistics, EA2694, University of Lille, CHRU Lille, France
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- * E-mail:
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Kochenov AV, Korogod SM. Impact of the Ratio of Metabotropic and Ionotropic Components of Parasympathetic Action on the Excitability of a Urinary Bladder Smooth Muscle Cell: a Simulation Study. NEUROPHYSIOLOGY+ 2016. [DOI: 10.1007/s11062-016-9562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Svennersten K, Hallén-Grufman K, de Verdier PJ, Wiklund NP, Poljakovic M. Localization of P2X receptor subtypes 2, 3 and 7 in human urinary bladder. BMC Urol 2015; 15:81. [PMID: 26253104 PMCID: PMC4529706 DOI: 10.1186/s12894-015-0075-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Voiding dysfunctions are a common problem that has a severe negative impact on the quality of life. Today there is a need for new drug targets for these conditions. The role of ATP receptors in bladder physiology has been studied for some time, primarily in animal models. The aim of this work is to investigate the localization of the ATP receptors P2X2, P2X3 and P2X7 and their colocalization with vimentin and actin in the human urinary bladder. METHODS Immunohistochemical analysis was conducted on full-thickness bladder tissues from fundus and trigonum collected from 15 patients undergoing open radical cystectomy due to chronic cystitis, bladder cancer or locally advanced prostate cancer. Colocalization analyses were performed between the three different P2X subtypes and the structural proteins vimentin and actin. Specimens were examined using epifluorescence microscopy and correlation coefficients were calculated for each costaining as well as the mean distance from the laminin positive basal side of the urothelium to the vimentin positive cells located in the suburothelium. RESULTS P2X2 was expressed in vimentin positive cells located in the suburothelium. Less distinct labelling of P2X2 was also observed in actin positive smooth muscle cells and in the urothelium. P2X3 was expressed in vimentin positive cells surrounding the smooth muscle, and in vimentin positive cells located in the suburothelium. Weaker P2X3 labelling was seen in the urothelium. P2X7 was expressed in the smooth muscle cells and the urothelium. In the suburothelium, cells double positive for P2X2 and vimentin where located closer to the urothelium while cells double positive for P2X3 and vimentin where located further from the urothelium. CONCLUSION The results from this study demonstrate that there is a significant difference in the expression of the purinergic P2X2, P2X3 and P2X7 receptors in the different histological layers of the human urinary bladder.
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Affiliation(s)
- Karl Svennersten
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
| | - Katarina Hallén-Grufman
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
| | - Petra J de Verdier
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - N Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
| | - Mirjana Poljakovic
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
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13
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Sacco E, Recupero S, Bientinesi R, Palermo G, D’Agostino D, Currò D, Bassi P. Pioneering drugs for overactive bladder and detrusor overactivity: Ongoing research and future directions. World J Obstet Gynecol 2015; 4:24-39. [DOI: 10.5317/wjog.v4.i2.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/31/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
The ongoing research on pioneering drug candidates for the overactive bladder (OAB) aimed to overcome the limitations of currently licensed pharmacotherapies, such as antimuscarinics, β3-adrenergic agents, and botulinum neurotoxin, has been reviewed performing a systematic literature review and web search. The review covers the exploratory agents alternative to available medications for OAB and that may ultimately prove to be therapeutically useful in the future management of OAB patients based on preclinical and early clinical data. It emerges that many alternative pharmacological strategies have been discovered or are under investigation in disease-oriented studies. Several potential therapeutics are known for years but still find obstacles to pass the clinical stages of development, while other completely novel compounds, targeting new pharmacological targets, have been recently discovered and show potential to translate into clinical therapeutic agents for idiopathic and neurogenic OAB syndrome. The global scenario of investigational drugs for OAB gives promise for the development of innovative therapeutics that may ultimately prove effective as first, combined or second-line treatments within a realistic timescale of ten years.
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14
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Ford AP, Undem BJ, Birder LA, Grundy D, Pijacka W, Paton JFR. P2X3 receptors and sensitization of autonomic reflexes. Auton Neurosci 2015; 191:16-24. [PMID: 25956567 DOI: 10.1016/j.autneu.2015.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A great deal of basic and applied physiology and pharmacology in sensory and autonomic neuroscience has teased apart mechanisms that drive normal perception of mechanical, thermal and chemical signals and convey them to CNS, the distinction of fiber types and receptors and channels that mediate them, and how they may become dysfunctional or maladaptive in disease. Likewise, regulation of efferent autonomic traffic to control organ reflexes has been well studied. In both afferent and efferent limbs, a wide array of potential therapeutic mechanisms has surfaced, some of which have progressed into clinic, if not full regrastration. One conversation that has been less well progressed relates to how the afferent limb and its sensitization shapes the efferent outputs, and where modulation may offer new therapeutic avenues, especially for poorly addressed and common signs and symptoms of disease. Therapeutics for CV disease (HF, hypertension), respiratory disease (asthma, COPD), urological disease (OAB), GI disease (IBS), and inter alia, have largely focused on the efferent control of effector cells to modulate movement, contraction and secretion; medicinal needs remain with limits to efficacy, AEs and treatment resistance being common. We now must turn, in the quest for improved therapeutics, to understand how sensation from these organs becomes maladapted and sensitized in disease, and what opportunities may arise for improved therapeutics given the abundance of targets, many pharmacologically untapped, on the afferent side. One might look at the treatment resistant hypertension and the emerging benefit of renal denervation; or urinary bladder overactivity / neurogenic bladder and the emergence of neuromodulation, capsaicin instillation or botox injections to attenuate sensitized reflexes, as examples of merely the start of such progress. This review examines this topic more deeply, as applies to four major organ systems all sharing a great need from unsatisfied patients.
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Affiliation(s)
| | - Bradley J Undem
- Johns Hopkins School of Medicine, Division of Allergy and Clinical Immunology, Baltimore, MD 21224, USA
| | - Lori A Birder
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA
| | - David Grundy
- Department of Biomedical Science, The University of Sheffield, Sheffield S10 2TN, UK
| | - Wioletta Pijacka
- School of Physiology & Pharmacology, Bristol CardioVascular, University of Bristol, Bristol, BS8 1TD, UK
| | - Julian F R Paton
- School of Physiology & Pharmacology, Bristol CardioVascular, University of Bristol, Bristol, BS8 1TD, UK
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15
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Hassan SS, Rachakatla R, McGarvey T, Youakeem MF. Morphological changes in the salivary acini after in vivo cholinergic stimulation. Neurourol Urodyn 2015; 35:574-81. [PMID: 25810148 DOI: 10.1002/nau.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/26/2015] [Indexed: 11/11/2022]
Abstract
AIMS Overactive bladder syndrome treated by muscarinic receptor antagonists may be complicated by reduced salivation. Cholinergic agonists may reverse this effect. The aim of the present study was to determine the antagonizing effect of a cholinergic agonist (carbachol) on a muscarinic receptor antagonist (oxybutynin) in the submandibular acini in a rat model. METHODS Forty male Sprague Dawley rats were divided into three groups: Group I (control), Group II (vehicle), and Group III (treatment). Group III was subdivided so Group IIIa was treated with a muscarinic receptor antagonist (oxybutynin) for 1 week, Group IIIb was treated with oxybutynin for 3 weeks, and Group IIIc was treated with oxybutynin for 1 week and oxybutynin and a cholinergic agonist (carbachol) for 2 weeks. Histological and ultrastructural studies were performed on submandibular glands. RESULTS Group IIIa showed moderate atrophic changes in the serous acini and ducts. Group IIIb showed serous acini with distorted wall, widening of the inter-lobar space, and deposition of mononuclear cells in the connective tissue. Group IIIc had serous acini similar to Group I, with mildly dilated inter-lobar ducts, but some serous acini revealed double nuclei and the inter-lobar duct showed luminal vacuolations. Ultrastructural studies confirmed histological results. CONCLUSIONS Muscarinic receptor antagonist administration led to changes in the submandibular gland of rats, while concomitant administration of cholinergic agonists seemed to counteract these atrophic changes. Additional studies should assess carbachol as a cholinergic agonist in treating dry mouth in patients with overactive bladder syndrome who are taking the muscarinic receptor. Neurourol. Urodynam. 35:574-581, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Sherif S Hassan
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri.,Department of Anatomy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Raja Rachakatla
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri
| | - Terence McGarvey
- Department of Anatomy, A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri
| | - Magdy F Youakeem
- Department of Anatomy, Faculty of Medicine, Cairo University, Cairo, Egypt
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16
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Franken J, Gevaert T, Uvin P, Wauterickx K, Boeve AC, Rietjens R, Boudes M, Hendriks JJA, Hellings N, Voets T, De Ridder D. Urodynamic changes in mice with experimental autoimmune encephalomyelitis correlate with neurological impairment. Neurourol Urodyn 2015; 35:450-6. [PMID: 25727376 DOI: 10.1002/nau.22742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/12/2015] [Indexed: 12/31/2022]
Abstract
AIMS Neurogenic bladder dysfunction is a major issue in Multiple Sclerosis (MS). High intravesical pressure should be treated early. Available therapies are insufficient and there is need for drug development and investigation of pathogenesis. Experimental Autoimmune Encephalomyelitis (EAE) in rodents is a well validated model to study MS. Previous research has shown that these animals develop urinary symptoms. However, from clinical studies, we know that symptoms do not necessarily reflect changes in bladder pressure. This paper aims to provide a complete overview of urodynamic changes in a model for detrusor overactivity in MS. METHODS Female C57Bl/6J mice, injected with MOG35-55 and control mice, injected with vehicle (Complete Freund's adjuvant), were monitored daily for neurologic symptoms. Within 1 month after symptom development, mice were used for cystometry or histology of the bladder. RESULTS Increasing disease score correlated with increased micturition frequency, basal pressure, and average pressure, and with a decrease in functional bladder capacity, voiding amplitude, and maximum pressure. CONCLUSIONS This paper provides a detailed description of bladder function in C57Bl/6J mice with Myelin Oligodendrocyte Glycoprotein peptide (MOG35-55 ) induced EAE. This EAE model induces detrusor overactivity in close relationship to neurological impairment. EAE in mice is a suitable model to study detrusor overactivity in MS. Neurourol. Urodynam. 35:450-456, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- J Franken
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium
| | - T Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium
| | - P Uvin
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium.,Hasselt University - Biomedical Research Institute, Diepenbeek, Belgium
| | - K Wauterickx
- Hasselt University - Biomedical Research Institute, Diepenbeek, Belgium
| | - A C Boeve
- Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium
| | - R Rietjens
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium
| | - M Boudes
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium
| | - J J A Hendriks
- Hasselt University - Biomedical Research Institute, Diepenbeek, Belgium
| | - N Hellings
- Hasselt University - Biomedical Research Institute, Diepenbeek, Belgium
| | - T Voets
- Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research and TRP Research Platform Leuven (TRPLe), KU Leuven - University of Leuven, Leuven, Belgium
| | - D De Ridder
- Department of Development and Regeneration, Laboratory of Experimental Urology, UZ Leuven - University of Leuven, Leuven, Belgium
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17
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Yu W, Sun X, Robson SC, Hill WG. ADP-induced bladder contractility is mediated by P2Y12 receptor and temporally regulated by ectonucleotidases and adenosine signaling. FASEB J 2014; 28:5288-98. [PMID: 25208846 DOI: 10.1096/fj.14-255885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purinergic signaling comprises one key pathway in modulating bladder smooth muscle (BSM) contractility, disorders of which become highly prevalent with aging. ADP was first observed to modulate BSM contractility >40 yr ago, yet the underlying molecular mechanism still remains unclear. Here, we demonstrate, using myography, that ADP and ADPβS dose-dependently induce mouse BSM contraction, and ADP-induced BSM contraction is blocked by a selective P2Y12 receptor (P2Y12R) antagonist, PSB 0739 (25 μM), but is unaffected by P2Y1 and P2Y13 receptor antagonists. P2Y12R in BSM exhibits distinct pharmacological properties that are different from P2Y12R in platelets. After an immediate contraction, prolonged exposure to ADP causes BSM to become refractory to further ADP-mediated contraction. However, in mice lacking ectonucleotidases Entpd1 (ATP→ADP→AMP) or Nt5e (AMP→adenosine), or by inhibiting adenosine signaling, the refractory response was altered, resulting in repeated BSM contractions in response to repeated ADP (0.1-1 mM) stimulation. Our data indicate that P2Y12R undergoes slow desensitization; ADP-P2Y12 signaling is tightly regulated by Entpd1/Nt5e activity and adenosine receptors; and ADP-adenosine signaling play an important role in modulating P2X-mediated BSM contraction. The identification of P2Y12R in BSM, and the current clinical availability of P2Y12R inhibitors, such as clopidogrel, offers potentially novel treatment strategies for bladder contractility disorders.
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Affiliation(s)
- Weiqun Yu
- Laboratory of Voiding Dysfunction, Division of Nephrology, and
| | - Xiaofeng Sun
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Simon C Robson
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren G Hill
- Laboratory of Voiding Dysfunction, Division of Nephrology, and
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18
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Franken J, Uvin P, De Ridder D, Voets T. TRP channels in lower urinary tract dysfunction. Br J Pharmacol 2014; 171:2537-51. [PMID: 24895732 PMCID: PMC4008998 DOI: 10.1111/bph.12502] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/17/2013] [Accepted: 10/20/2013] [Indexed: 12/13/2022] Open
Abstract
Lower urinary tract dysfunction (LUTd) represents a major healthcare problem. Although it is mostly not lethal, associated social disturbance, medical costs, loss of productivity and especially diminished quality of life should not be underestimated. Although more than 15% of people suffer from a form of LUTd to some extent, pathophysiology often remains obscure. In the past 20 years, transient receptor potential (TRP) channels have become increasingly important in this field of research. These intriguing ion channels are believed to be the main molecular sensors that generate bladder sensation. Therefore, they are intensely pursued as new drug targets for both curative and symptomatic treatment of different forms of LUTd. TRPV1 was the first of its class to be investigated. Actually, even before this channel was cloned, it had already been targeted in the bladder, with clinical trials of intravesical capsaicin instillations. Several other polymodally gated TRP channels, particularly TRPM8, TRPA1 and TRPV4, also appear to play a prominent role in bladder (patho)physiology. With this review, we provide a brief overview of current knowledge on the role of these TRP channels in LUTd and their potential as molecular targets for treatment.
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Affiliation(s)
- J Franken
- Laboratory of Experimental Urology, KU LeuvenLeuven, Belgium
| | - P Uvin
- Laboratory of Experimental Urology, KU LeuvenLeuven, Belgium
| | - D De Ridder
- Laboratory of Experimental Urology, KU LeuvenLeuven, Belgium
| | - T Voets
- Laboratory of Ion Channel Research, KU LeuvenLeuven, Belgium
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19
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Burnstock G. Purinergic signalling in the urinary tract in health and disease. Purinergic Signal 2014; 10:103-55. [PMID: 24265069 PMCID: PMC3944045 DOI: 10.1007/s11302-013-9395-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022] Open
Abstract
Purinergic signalling is involved in a number of physiological and pathophysiological activities in the lower urinary tract. In the bladder of laboratory animals there is parasympathetic excitatory cotransmission with the purinergic and cholinergic components being approximately equal, acting via P2X1 and muscarinic receptors, respectively. Purinergic mechanosensory transduction occurs where ATP, released from urothelial cells during distension of bladder and ureter, acts on P2X3 and P2X2/3 receptors on suburothelial sensory nerves to initiate the voiding reflex, via low threshold fibres, and nociception, via high threshold fibres. In human bladder the purinergic component of parasympathetic cotransmission is less than 3 %, but in pathological conditions, such as interstitial cystitis, obstructed and neuropathic bladder, the purinergic component is increased to 40 %. Other pathological conditions of the bladder have been shown to involve purinoceptor-mediated activities, including multiple sclerosis, ischaemia, diabetes, cancer and bacterial infections. In the ureter, P2X7 receptors have been implicated in inflammation and fibrosis. Purinergic therapeutic strategies are being explored that hopefully will be developed and bring benefit and relief to many patients with urinary tract disorders.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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20
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Daly DM, Nocchi L, Liaskos M, McKay NG, Chapple C, Grundy D. Age-related changes in afferent pathways and urothelial function in the male mouse bladder. J Physiol 2013; 592:537-49. [PMID: 24297847 PMCID: PMC3930438 DOI: 10.1113/jphysiol.2013.262634] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The prevalence of lower urinary tract storage disorders such as overactive bladder syndrome and urinary incontinence significantly increase with age. Previous studies have demonstrated age-related changes in detrusor function and urothelial transmitter release but few studies have investigated how the urothelium and sensory pathways are affected. The aim of this study was to investigate the effect of ageing on urothelial-afferent signalling in the mouse bladder. Three-month-old control and 24-month-old aged male mice were used. In vivo natural voiding behaviour, sensory nerve activity, urothelial cell function, muscle contractility, transmitter release and gene and protein expression were measured to identify how all three components of the bladder (neural, contractile and urothelial) are affected by ageing. In aged mice, increased voiding frequency and enhanced low threshold afferent nerve activity was observed, suggesting that ageing induces overactivity and hypersensitivity of the bladder. These changes were concurrent with altered ATP and acetylcholine bioavailability, measured as transmitter overflow into the lumen, increased purinergic receptor sensitivity and raised P2X3 receptor expression in the urothelium. Taken together, these data suggest that ageing results in aberrant urothelial function, increased afferent mechanosensitivity, increased smooth muscle contractility, and changes in gene and protein expression (including of P2X3). These data are consistent with the hypothesis that ageing evokes changes in purinergic signalling from the bladder, and further studies are now required to fully validate this idea.
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Affiliation(s)
- Donna M Daly
- Department of Biomedical Science, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
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