1
|
Westropp JL, Stella JL, Buffington CAT. Interstitial cystitis-an imbalance of risk and protective factors? FRONTIERS IN PAIN RESEARCH 2024; 5:1405488. [PMID: 38784787 PMCID: PMC11112028 DOI: 10.3389/fpain.2024.1405488] [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: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
Interstitial cystitis (IC) presents as a chronic pain condition with variable combinations of symptoms depending on the species and individual patient. It is diagnosed by the presence of lower urinary tract signs and symptoms in combination with a variety of comorbid health problems, a history of life adversities, and the absence of other conditions that could cause the lower urinary tract signs. IC occurs naturally in humans and cats as a dimensional condition, with patients presenting with mild, moderate, and severe symptoms. Most patients appear to recover without specific treatment. A number of rodent models of IC have been used to study its causes and treatments. Unfortunately, current therapies generally fail to ameliorate IC symptoms long-term. The recent classification of IC as a chronic primary pain disorder calls for a rethinking of current clinical and research approaches to it. Beginning when a patient encounters a clinician, precipitating, perpetuating, and palliating risk factors can be addressed until a cause or reliably effective therapy is identified, and identifying predisposing and preventive factors can inform epidemiological studies and health promotion interventions. Predisposing, precipitating, and perpetuating risk factors, including environmental, psychological, and biological, increase the activity of the central threat response system (CTRS), which plays a clinically important role in IC symptoms. Studies in cats and rodent models have revealed that environmental enrichment (EE), in the absence of bladder-directed therapies, leads to amelioration of IC symptoms, implying a central role for the CTRS in symptom precipitation and perpetuation. Conceptually moving the source of IC pain to the brain as a motivational state rather than one resulting from peripheral nociceptive input offers both clinicians and researchers novel opportunities to improve care for patients with IC and for researchers to use more ecologically valid rodent models. It may even be that IC results from an excess of risk to protective factors, making this imbalance a targetable cause rather than a consequence of IC.
Collapse
Affiliation(s)
- Jodi L. Westropp
- Department of Medicine and Epidemiology, UC Davis School of Veterinary Medicine, Davis, CA, United States
| | - Judith L. Stella
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, W. Lafayette, IN, United States
| | - C. A. Tony Buffington
- Department of Medicine and Epidemiology, UC Davis School of Veterinary Medicine, Davis, CA, United States
| |
Collapse
|
2
|
Gao Y, Rodríguez LV. The Effect of Chronic Psychological Stress on Lower Urinary Tract Function: An Animal Model Perspective. Front Physiol 2022; 13:818993. [PMID: 35388285 PMCID: PMC8978557 DOI: 10.3389/fphys.2022.818993] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic psychological stress can affect urinary function and exacerbate lower urinary tract (LUT) dysfunction (LUTD), particularly in patients with overactive bladder (OAB) or interstitial cystitis–bladder pain syndrome (IC/BPS). An increasing amount of evidence has highlighted the close relationship between chronic stress and LUTD, while the exact mechanisms underlying it remain unknown. The application of stress-related animal models has provided powerful tools to explore the effect of chronic stress on LUT function. We systematically reviewed recent findings and identified stress-related animal models. Among them, the most widely used was water avoidance stress (WAS), followed by social stress, early life stress (ELS), repeated variable stress (RVS), chronic variable stress (CVS), intermittent restraint stress (IRS), and others. Different types of chronic stress condition the induction of relatively distinguished changes at multiple levels of the micturition pathway. The voiding phenotypes, underlying mechanisms, and possible treatments of stress-induced LUTD were discussed together. The advantages and disadvantages of each stress-related animal model were also summarized to determine the better choice. Through the present review, we hope to expand the current knowledge of the pathophysiological basis of stress-induced LUTD and inspire robust therapies with better outcomes.
Collapse
Affiliation(s)
- Yunliang Gao
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Larissa V. Rodríguez
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Larissa V. Rodríguez,
| |
Collapse
|
3
|
Chaves T, Fazekas CL, Horváth K, Correia P, Szabó A, Török B, Bánrévi K, Zelena D. Stress Adaptation and the Brainstem with Focus on Corticotropin-Releasing Hormone. Int J Mol Sci 2021; 22:ijms22169090. [PMID: 34445795 PMCID: PMC8396605 DOI: 10.3390/ijms22169090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
Stress adaptation is of utmost importance for the maintenance of homeostasis and, therefore, of life itself. The prevalence of stress-related disorders is increasing, emphasizing the importance of exploratory research on stress adaptation. Two major regulatory pathways exist: the hypothalamic–pituitary–adrenocortical axis and the sympathetic adrenomedullary axis. They act in unison, ensured by the enormous bidirectional connection between their centers, the paraventricular nucleus of the hypothalamus (PVN), and the brainstem monoaminergic cell groups, respectively. PVN and especially their corticotropin-releasing hormone (CRH) producing neurons are considered to be the centrum of stress regulation. However, the brainstem seems to be equally important. Therefore, we aimed to summarize the present knowledge on the role of classical neurotransmitters of the brainstem (GABA, glutamate as well as serotonin, noradrenaline, adrenaline, and dopamine) in stress adaptation. Neuropeptides, including CRH, might be co-localized in the brainstem nuclei. Here we focused on CRH as its role in stress regulation is well-known and widely accepted and other CRH neurons scattered along the brain may also complement the function of the PVN. Although CRH-positive cells are present on some parts of the brainstem, sometimes even in comparable amounts as in the PVN, not much is known about their contribution to stress adaptation. Based on the role of the Barrington’s nucleus in micturition and the inferior olivary complex in the regulation of fine motoric—as the main CRH-containing brainstem areas—we might assume that these areas regulate stress-induced urination and locomotion, respectively. Further studies are necessary for the field.
Collapse
Affiliation(s)
- Tiago Chaves
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Csilla Lea Fazekas
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Krisztina Horváth
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Pedro Correia
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Adrienn Szabó
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Bibiána Török
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Janos Szentagothai School of Neurosciences, Semmelweis University, 1083 Budapest, Hungary
| | - Krisztina Bánrévi
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
| | - Dóra Zelena
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, 1083 Budapest, Hungary; (T.C.); (C.L.F.); (K.H.); (P.C.); (A.S.); (B.T.); (K.B.)
- Centre for Neuroscience, Szentágothai Research Centre, Institute of Physiology, Medical School, University of Pécs, 7624 Pécs, Hungary
- Correspondence:
| |
Collapse
|
4
|
Shimizu T, Shimizu S, Higashi Y, Saito M. Psychological/mental stress-induced effects on urinary function: Possible brain molecules related to psychological/mental stress-induced effects on urinary function. Int J Urol 2021; 28:1093-1104. [PMID: 34387005 DOI: 10.1111/iju.14663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Exposure to psychological/mental stress can affect urinary function, and lead to and exacerbate lower urinary tract dysfunctions. There is increasing evidence showing stress-induced changes not only at phenomenological levels in micturition, but also at multiple levels, lower urinary tract tissues, and peripheral and central nervous systems. The brain plays crucial roles in the regulation of the body's responses to stress; however, it is still unclear how the brain integrates stress-related information to induce changes at these multiple levels, thereby affecting urinary function and lower urinary tract dysfunctions. In this review, we introduce recent urological studies investigating the effects of stress exposure on urinary function and lower urinary tract dysfunctions, and our recent studies exploring "pro-micturition" and "anti-micturition" brain molecules related to stress responses. Based on evidence from these studies, we discuss the future directions of central neurourological research investigating how stress exposure-induced changes at peripheral and central levels affect urinary function and lower urinary tract dysfunctions. Brain molecules that we explored might be entry points into dissecting the stress-mediated process for modulating micturition.
Collapse
Affiliation(s)
- Takahiro Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Youichirou Higashi
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Motoaki Saito
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| |
Collapse
|