1
|
Dmochowski RR, Newman DK, Rovner ES, Zillioux J, Malik RD, Ackerman AL. Patient and Clinician Challenges with Anticholinergic Step Therapy in the Treatment of Overactive Bladder: A Narrative Review. Adv Ther 2023; 40:4741-4757. [PMID: 37725308 PMCID: PMC10567877 DOI: 10.1007/s12325-023-02625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β3-adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β3-agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers.
Collapse
Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Lenore Ackerman
- Departments of Urology and Obstetrics and Gynecology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Box 951738, Los Angeles, CA, 90095-1738, USA.
| |
Collapse
|
2
|
Grenier C, Lopes FM, Cueto-González AM, Rovira-Moreno E, Gander R, Jarvis BW, McCloskey KD, Gurney AM, Beaman GM, Newman WG, Woolf AS, Roberts NA. Neurogenic Defects Occur in LRIG2-Associated Urinary Bladder Disease. Kidney Int Rep 2023; 8:1417-1429. [PMID: 37441484 PMCID: PMC10334403 DOI: 10.1016/j.ekir.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Urofacial, or Ochoa, syndrome (UFS) is an autosomal recessive disease featuring a dyssynergic bladder with detrusor smooth muscle contracting against an undilated outflow tract. It also features an abnormal grimace. Half of individuals with UFS carry biallelic variants in HPSE2, whereas other rare families carry variants in LRIG2.LRIG2 is immunodetected in pelvic ganglia sending autonomic axons into the bladder. Moreover, Lrig2 mutant mice have abnormal urination and abnormally patterned bladder nerves. We hypothesized that peripheral neurogenic defects underlie LRIG2-associated bladder dysfunction. Methods We describe a new family with LRIG2-associated UFS and studied Lrig2 homozygous mutant mice with ex vivo physiological analyses. Results The index case presented antenatally with urinary tract (UT) dilatation, and postnatally had urosepsis and functional bladder outlet obstruction. He had the grimace that, together with UT disease, characterizes UFS. Although HPSE2 sequencing was normal, he carried a homozygous, predicted pathogenic, LRIG2 stop variant (c.1939C>T; p.Arg647∗). Lrig2 mutant mice had enlarged bladders. Ex vivo physiology experiments showed neurogenic smooth muscle relaxation defects in the outflow tract, containing the urethra adjoining the bladder, and in detrusor contractility. Moreover, there were nuanced differences in physiological outflow tract defects between the sexes. Conclusion Putting this family in the context of all reported UT disease-associated LRIG2 variants, the full UFS phenotype occurs with biallelic stop or frameshift variants, but missense variants lead to bladder-limited disease. Our murine observations support the hypothesis that UFS is a genetic autonomic neuropathy of the bladder affecting outflow tract and bladder body function.
Collapse
Affiliation(s)
- Celine Grenier
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Filipa M. Lopes
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Anna M. Cueto-González
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Catalonia, Spain
- Medicine Genetics Group, Vall Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Eulàlia Rovira-Moreno
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Catalonia, Spain
- Medicine Genetics Group, Vall Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Romy Gander
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall D'Hebron Barcelona, Hospital Vall D'Hebron, Barcelona, Spain
| | - Benjamin W. Jarvis
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Karen D. McCloskey
- Patrick G. Johnston Center for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Alison M. Gurney
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Glenda M. Beaman
- Manchester Center for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - William G. Newman
- Manchester Center for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Human Sciences, University of Manchester, Manchester, UK
| | - Adrian S. Woolf
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | - Neil A. Roberts
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Jones SE, Harvey PD. Cross-diagnostic determinants of cognitive functioning: the muscarinic cholinergic receptor as a model system. Transl Psychiatry 2023; 13:100. [PMID: 36973270 PMCID: PMC10042838 DOI: 10.1038/s41398-023-02400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Cognitive impairment is a predictor of disability across different neuropsychiatric conditions, and cognitive abilities are also strongly related to educational attainment and indices of life success in the general population. Previous attempts at drug development for cognitive enhancement have commonly attempted to remedy defects in transmitters systems putatively associated with the conditions of interest such as the glutamate system in schizophrenia. Recent studies of the genomics of cognitive performance have suggested influences that are common in the general population and in different neuropsychiatric conditions. Thus, it seems possible that transmitter systems that are implicated for cognition across neuropsychiatric conditions and the general population would be a viable treatment target. We review the scientific data on cognition and the muscarinic cholinergic receptor system (M1 and M4) across different diagnoses, in aging, and in the general population. We suggest that there is evidence suggesting potential beneficial impacts of stimulation of critical muscarinic receptors for the enhancement of cognition in a broad manner, as well as the treatment of psychotic symptoms. Recent developments make stimulation of the M1 receptor more tolerable, and we identify the potential benefits of M1 and M4 receptor stimulation as a trans-diagnostic treatment model.
Collapse
Affiliation(s)
- Sara E Jones
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA.
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
| |
Collapse
|
4
|
Panevin TS, Ananyeva LP. Pathogenetic rationale for prescribing menopausal hormone therapy for systemic sclerosis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-538-545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic scleroderma (SS) is characterized by dysregulation of the innate and adaptive immune systems, vasculopathy, and generalized fibrosis. As with most autoimmune diseases, women predominate among patients, who get sick 3–14 times more often than men. It is assumed that gender differences and modulation of sex hormones are essential in the pathogenesis of SS. Estrogens are able to influence the immune response, have a vasodilating effect and stimulate the synthesis of collagen in the skin. The development of SS leads to a significant decrease in the quality of life, psychological disorders associated with changes in appearance, as well as the need for lifelong medication with the frequent development of side effects. Age-related estrogen deficiency associated with the onset of menopause is accompanied by a decrease in the quality of life and, in some cases, a change in the clinical manifestations of somatic diseases. This review considers the impact of menopause and menopausal hormone therapy (MHT) on the course and clinical manifestations of systemic scleroderma. It is noted that SS in some cases is accompanied by an early onset of menopause. The use of MHT is not associated with the progression of cutaneous fibrosis, and may also improve the vascular manifestations of SS.
Collapse
|
5
|
Okimoto R, Ino K, Ishizu K, Takamatsu H, Sakamoto K, Yuyama H, Imazumi K, Ohtake A, Masuda N, Takeda M. Muscarinic M 3 positive allosteric modulator ASP8302 enhances bladder contraction and improves voiding dysfunction in rats. Low Urin Tract Symptoms 2022; 14:289-300. [PMID: 35150075 DOI: 10.1111/luts.12430] [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: 11/05/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Muscarinic M3 (M3 ) receptors mediate cholinergic smooth muscle contraction of the bladder. Current drugs targeting bladder M3 receptors for micturition disorders have a risk of cholinergic side effects due to excessive receptor activation and insufficient selectivity. We investigated the effect of ASP8302, a novel positive allosteric modulator (PAM) of M3 receptors, on bladder function in rats. METHODS Modulation of carbachol-induced increases in intracellular Ca2+ was assessed in cells expressing rat muscarinic receptors. Potentiation of bladder contractions was evaluated using isolated rat bladder strips and by measuring intravesical pressure in anesthetized rats. Conscious cystometry was performed to investigate the effects on residual urine volume and voiding efficiency in rat voiding dysfunction models induced by the α1 -adrenoceptor agonist midodrine and muscarinic receptor antagonist atropine, and bladder outlet obstruction. To assess potential side effects, the number of stools and tracheal insufflation pressure were measured in conscious and anesthetized rats, respectively. RESULTS ASP8302 demonstrated PAM effects on the rat M3 receptor in cell assays, and augmented cholinergic bladder contractions both in vivo and in vitro. ASP8302 improved voiding efficiency and reduced residual urine volume in two voiding dysfunction models as effectively as distigmine bromide, but unlike distigmine bromide did not affect the number of stools or tracheal insufflation pressure. CONCLUSIONS Our results in rats indicate that ASP8302 improves voiding dysfunction by potentiating bladder contraction with fewer effects on cholinergic responses in other organs, and suggest a potential advantage over current cholinomimetic drugs for treating micturition disorders caused by insufficient bladder contraction.
Collapse
Affiliation(s)
- Risa Okimoto
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| | - Katsutoshi Ino
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| | | | | | | | - Hironori Yuyama
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| | | | - Akiyoshi Ohtake
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| | - Noriyuki Masuda
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| | - Masahiro Takeda
- Drug Discovery Research, Astellas Pharma Inc, Ibaraki, Japan
| |
Collapse
|
6
|
Okimoto R, Ino K, Ishizu K, Takamatsu H, Sakamoto K, Yuyama H, Fuji H, Someya A, Ohtake A, Ishigami T, Masuda N, Takeda M, Kajioka S, Yoshimura N. Potentiation of muscarinic M3 receptor activation through a new allosteric site with a nove l positive allosteric modulator ASP8302. J Pharmacol Exp Ther 2021; 379:64-73. [PMID: 34244231 DOI: 10.1124/jpet.121.000709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022] Open
Abstract
Muscarinic M3 (M3) receptors mediate a wide range of acetylcholine (ACh)-induced functions, including visceral smooth muscle contraction and glandular secretion. Positive allosteric modulators (PAMs) can avoid various side effects of muscarinic agonists with their spatiotemporal receptor activation control and potentially better subtype selectivity. However, the mechanism of allosteric modulation of M3 receptors is not fully understood, presumably due to the lack of a potent and selective PAM. In this study, we investigated the pharmacological profile of ASP8302, a novel PAM of M3 receptors, and explored the principal site of amino acid sequences in the human M3 receptor required for the potentiation of receptor activation. In cells expressing human M3 and M5 receptors, ASP8302 shifted the concentration-response curve (CRC) for carbachol to the lower concentrations with no significant effects on other subtypes. In a binding study with M3 receptor-expressing membrane, ASP8302 also shifted the CRC for ACh without affecting the binding of orthosteric agonists. Similar shifts in the CRC of contractions by multiple stimulants were also confirmed in isolated human bladder strips. Mutagenesis analysis indicated no interaction between ASP8302 and previously reported allosteric sites; however, identified threonine 230 as the amino acid essential for the PAM effect of ASP8302. These results demonstrate that ASP8302 enhances the activation of human M3 receptors by interacting with a single amino acid distinct from the reported allosteric sites. Our findings suggest not only a novel allosteric site of M3 receptors but also the potential application of ASP8302 to diseases caused by insufficient M3 receptor activation. Significance Statement The significance of this study is that the novel M3 receptor positive allosteric modulator ASP8302 enhances the activation of human M3 receptor by interacting with a residue distinct from the reported allosteric sites. The finding of Thr230 as a novel amino acid involved in the allosteric modulation of M3 receptors provides significant insight into further research of the mechanism of allosteric modulation of M3 and other muscarinic receptors.
Collapse
Affiliation(s)
- Risa Okimoto
- Drug Discovery Research, Astellas Pharma Inc., Japan
| | | | | | | | - Kazuyuki Sakamoto
- Research Program Management Office, Drug Discovery Research, Astellas Pharma Inc., Japan
| | | | | | | | | | | | | | | | - Shunichi Kajioka
- Department of Pharmaceutical Sciences, International University of Health and Welfare, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, United States
| |
Collapse
|
7
|
Kashyap M, Singh N, Yoshimura N, Chermansky C, Tyagi P. Constitutively active HCN channels constrain detrusor excitability and modulate evoked contractions of human bladder. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2020; 8:163-176. [PMID: 33235894 PMCID: PMC7677517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Expression of Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels is reported in bladder, but the functional role remains unsettled. Here, we immunolocalized the HCN1 and HCN4 subtype in human bladder and investigated their functional significance. METHODS Bladder procured from ten organ donors was dissected into mucosa (containing urothelium and submucosa) and detrusor for double immunofluorescence of HCN1 and 4 subtypes with gap junction and neural proteins together with isometric tension recordings. Mucosa intact and denuded detrusor strips were stretched to a basal tension of 10 mN for eliciting either tetrodotoxin (TTX) resistant spontaneous, carbachol evoked contractions and TTX sensitive electrical field stimulated (EFS), pre and post-addition of HCN blocker, ZD7288 or the activator, Lamotrigine or the cholinesterase inhibitor, Neostigmine. RESULTS Double immunofluorescence revealed immunolocalization of HCN1 and HCN4 subtype with calcitonin gene related peptide (CGRP), choline acetyl transferase and gap junction proteins in mucosa and detrusor. Removal of mucosa significantly raised the resting tension and the force of spontaneous contractions upon cumulative addition of ZD7288 in micromolar range relative to Lamotrigine treated strips (P<0.05). ZD7288 [10 nM] did not affect the contractile response evoked by EFS or carbachol, but the addition of ZD7288 [10 nM] in presence of Neostigmine [1 µM] significantly enhanced the atropine and TTX sensitive EFS evoked contractions of mucosa denuded strips. CONCLUSIONS Overall, HCN channels immunolocalized in mucosa, smooth muscle, gap junctions and nerve fibers exert a tonic constraint on detrusor excitability, enable spatio-temporal integration of evoked contractions and constrain the release of neurotransmitters, respectively. In contrast to the pacemaker role in other organs, findings argue for a non-pacemaking role of HCN channels in human bladder.
Collapse
Affiliation(s)
| | - Nishant Singh
- Department of Urology, University of PittsburghPittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of PittsburghPittsburgh, PA, USA
| | | | - Pradeep Tyagi
- Department of Urology, University of PittsburghPittsburgh, PA, USA
| |
Collapse
|
8
|
Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms. Int Neurourol J 2020; 24:231-240. [PMID: 33017894 PMCID: PMC7538292 DOI: 10.5213/inj.2040082.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.
Collapse
|
9
|
Araklitis G, Robinson D. The cognitive safety of antimuscarinics in the treatment of overactive bladder. Expert Opin Drug Saf 2020; 19:1303-1313. [PMID: 32857638 DOI: 10.1080/14740338.2020.1817377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Overactive bladder is a common problem women suffer from, with its incidence increasing with age. The mainstay of treatment is antimuscarinic medication. There is growing evidence that antimuscarinics may increase the risk of cognitive impairment, dementia, and even death. AREAS COVERED This review explores the evidence that antimuscarinics increase the risk of cognitive impairment, dementia, and death. It evaluates how best to treat overactive bladder the older woman. EXPERT OPINION The evidence suggests that antimuscarinics increase the risk of cognitive impairment and dementia in the older adult. Care should be taken to use an antimuscarinic that is less likely to cross the blood-brain barrier and thus reduce the risk of these significant adverse events. A patient's anticholinergic load also needs to be considered when treating this group. Other treatment options such as fluid management, bladder retraining, vaginal estrogens, mirabegron, Onabotulinum toxin A and neuromodulation can be used instead.
Collapse
Affiliation(s)
| | - Dudley Robinson
- Urogynaecology Department, King's College Hospital , London, UK
| |
Collapse
|
10
|
Singh N, Mizoguchi S, Suzuki T, Zabbarova I, Ikeda Y, Kanai A, Chermansky C, Yoshimura N, Tyagi P. Excitatory effect of acotiamide on rat and human bladder: Implications for underactive bladder treatment. Life Sci 2020; 258:118179. [PMID: 32758626 DOI: 10.1016/j.lfs.2020.118179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether approved gastroprokinetic agent, acotiamide exerts a direct excitatory effect on bladder to help explain the reported meaningful reduction of post-void residual urine volume (PVR) in detrusor underactivity (DU) patients after thrice daily oral intake of acotiamide 100 mg for 2 weeks. METHODS Effect of acotiamide [1-16 μM] was assessed on nerve-mediated contractions evoked by electrical field stimulation (EFS) for 5 s with 5 ms pulse trains of 10 V in longitudinal, mucosa intact rat and human bladder strips to construct frequency response curve (1-32 Hz) and repeat 10 Hz stimulation at 60s interval. Effect of acotiamide 2 μM on spontaneous and carbachol evoked contractions was also assessed. RESULTS Acotiamide 2 μM significantly enhanced the Atropine and Tetrodotoxin (TTX)-sensitive EFS evoked contractions of rat and human bladder at 8-32 Hz (Two-way ANOVA followed Sidak's multiple comparison; *p < 0.01) and on repeat 10 Hz stimulation (Paired Student's t-test; *p < 0.05), while producing a modest effect on the spontaneous contractions and a negligible effect on the carbachol evoked contractions. CONCLUSIONS Enhancement of TTX-sensitive evoked contractions of rat and human bladder by acotiamide is consistent with the enhancement of excitatory neuro-effector transmission mainly through prejunctional mechanisms. Findings highlight immense therapeutic potential of antimuscarinics with low M3 receptor affinity like acotiamide in Underactive bladder (UAB)/DU treatment.
Collapse
Affiliation(s)
- Nishant Singh
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Shinsuke Mizoguchi
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Takahisa Suzuki
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Irina Zabbarova
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Youko Ikeda
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Anthony Kanai
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Christopher Chermansky
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, United States of America.
| |
Collapse
|
11
|
Mostafaei H, Shariat SF, Salehi-Pourmehr H, Janisch F, Mori K, Quhal F, Hajebrahimi S. The clinical pharmacology of the medical treatment for overactive bladder in adults. Expert Rev Clin Pharmacol 2020; 13:707-720. [PMID: 32500759 DOI: 10.1080/17512433.2020.1779056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Overactive bladder is a prevalent symptom complex that affects the patient's quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium. AREAS COVERED In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB. EXPERT OPINION OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.
Collapse
Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University , Moscow, Russia.,Department of Urology, University of Texas Southwestern Medical Center , Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University , Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College , New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology , Vienna, Austria.,Department of Urology, University of Jordan , Amman, Jordan
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Florian Janisch
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, Medical University of Hamburg , Hamburg, Germany
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, The Jikei University School of Medicine , Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,King Fahad Specialist Hospital-Dammam , Saudi Arabia
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| |
Collapse
|
12
|
Chen Y, Canal CE. Structure-Activity Relationship Study of Psychostimulant Synthetic Cathinones Reveals Nanomolar Antagonist Potency of α-Pyrrolidinohexiophenone at Human Muscarinic M 2 Receptors. ACS Chem Neurosci 2020; 11:960-968. [PMID: 32073252 DOI: 10.1021/acschemneuro.0c00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Synthetic cathinones (SCs) are designer, psychostimulant drugs of abuse that primarily act on monoamine transporters; little is known about their off-target liability. Abuse of pyrrolidine-containing SCs, such as α-PHP, has been linked to clinical features, including tachycardia and hypertension, and psychiatric events, including delusions and memory impairments-effects mimicking deliriant hallucinogens that are acetylcholine muscarinic receptor (MR) antagonists. α-PHP and nine analogs with modifications in the α-carbon side chain length and/or containing a methylenedioxy moiety were screened for activity at each of the five human MRs. Increasing the length of the α-carbon side chain of 1-phenyl-2-(pyrrolidin-1-yl)ethan-1-one analogs from a methyl (α-PPP) to a propyl (α-PVP) group caused a steep increase in affinity at all MR subtypes, and one extra carbon (α-PHP) further enhanced MR affinity; the presence of a methylenedioxy moiety generally hindered this effect. Highest MR affinity was observed with α-PHP at M2Rs-its M2R affinity (Ki = 251 nM) was 302-fold higher than α-PPP's. M2R-cAMP inhibition and β-arrestin recruitment assays showed that α-PHP is an M2R antagonist (Kb = 120 and 502 nM, respectively). Additional experiments showed α-PHP is also an antagonist of M1R-inositol phosphate production (Kb = 1.4 μM). Human toxicology studies report blood concentrations of pyrrolidine-containing SCs, including α-PHP, that reach micromolar levels during intoxication, indicating α-PHP's MR activity might have physiological relevance. As M2Rs and M1Rs are widely expressed in the autonomic and central nervous systems, α-PHP's anticholinergic activity might be relevant to adverse events associated with α-PHP intoxication.
Collapse
Affiliation(s)
- Yiming Chen
- Department of Pharmaceutical Sciences, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| | - Clinton E. Canal
- Department of Pharmaceutical Sciences, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| |
Collapse
|
13
|
Chen S, Liao B, Jin X, Wei T, He Q, Lin Y, Ai J, Gong L, Li H, Wang K. M
3
receptor modulates extracellular matrix synthesis via ERK1/2 signaling pathway in human bladder smooth muscle cells. J Cell Biochem 2020; 121:4496-4504. [PMID: 32065420 DOI: 10.1002/jcb.29688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Shulian Chen
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
- Department of Urology Affiliated Hospital of Zunyi Medical University Zunyi Guizhou China
| | - Banghua Liao
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Xi Jin
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Tangqiang Wei
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Qing He
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Yifei Lin
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Jianzhong Ai
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Lina Gong
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Hong Li
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Kunjie Wang
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| |
Collapse
|
14
|
John G. Systemic sclerosis and urinary symptoms: a complex pathophysiology. Clin Rheumatol 2019; 39:5-8. [PMID: 31376088 DOI: 10.1007/s10067-019-04714-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
Lower urinary tract symptoms (LUTS) have long been overlooked in systemic sclerosis (SSc). However, they are out of proportion of what would be expected based on age, sex, and presence of usual risk factors. Thus, there must be specific scleroderma-related mechanisms to result in LUTS. Fibrosis, nervous involvement (notably, dysautonomia), early signs of menopauses, and functional restriction play certainly a role, but available evidence shows inconsistent results. Thus, these factors are not sufficient to explain all aspect of LUTS in SSc. In vitro experiments point out a promising alternative mechanism, already observed in other rheumatologic diseases: an antibody-mediated etiology. However, more research is needed to better understand the pathophysiology of LUTS in SSc and develop specific treatment.
Collapse
Affiliation(s)
- Gregor John
- Department of Internal Medicine, Hôpital neuchâtelois, Rue de la Maladière 45, 2000, Neuchâtel, Switzerland. .,Department of Internal Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland. .,Geneva University, 1205, Geneva, Switzerland.
| |
Collapse
|
15
|
Paily A, Preziosi G, Trivedi P, Emmanuel A. Anti-muscarinic drugs increase rectal compliance and exacerbate constipation in chronic spinal cord injury : Anti-muscarinic drug effect on neurogenic bowel. Spinal Cord 2019; 57:662-668. [PMID: 30804425 DOI: 10.1038/s41393-019-0263-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN Prospective cohort study OBJECTIVES: We hypothesized that anti-muscarinic agents alter rectal compliance in SCI patients and that altered rectal compliance relates to bowel symptomatology. Our primary aim was to compare rectal compliance before and after the institution of anti-muscarinics (solifenacin and tolterodine) and an adrenoceptor agonist (mirabegron) in these patients. Additionally, we wanted to evaluate if anorectal manometry differed before and after use of anti-muscarinic agents. SETTING Tertiary neurogastroenterology clinic, London METHODS: Thirty-five patients with supraconal spinal cord injury (SCI) underwent anal manometry, assessment of rectoanal inhibitory reflex (RAIR) and rectal compliance before and after anti-muscarinic treatment (for overactive bladder) was started (mean follow-up 12 weeks). Patients were assessed identically, pre-and post-treatment (solifenacin n = 17, tolterodine n = 10, mirabegron n = 8). Doses used were as for non-SCI patients. RESULTS Resting, squeeze and cough pressures were unchanged after anti-muscarinic treatment. Rectal compliance was significantly raised after anti-muscarinic treatment (p = 0.001). The percent amplitude of maximal sphincter relaxation of the RAIR was decreased (p < 0.001) and excitation latency was increased (p = 0.006). There was no significant change in the duration of recovery of the RAIR. There was a significant increase of the Wexner Constipation Score (p = 0.001) but no change in the Wexner Incontinence Score. There was a significant correlation between change in rectal compliance and change in Wexner Constipation Score (p = 0.001). Thus, increasing compliance of the rectum is associated with worsening of constipation after anti-muscarinic therapy. However, there were no changes in anorectal manometry or rectal compliance in those who received mirabegron. CONCLUSION Anti-muscarinic therapy for overactive bladder increases compliance of the neurogenic rectum and alters anorectal reflex activity, with worsening of constipation.
Collapse
Affiliation(s)
- Abhilash Paily
- Department of GI Physiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. .,Department of Gastroenterology, Spinal Injuries Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Guiseppe Preziosi
- Department of GI Physiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Prateesh Trivedi
- Department of GI Physiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Anton Emmanuel
- Department of GI Physiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,Department of Gastroenterology, Spinal Injuries Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| |
Collapse
|
16
|
Abstract
Antimuscarinic agents are now widely used as the pharmacological therapy for overactive bladder (OAB) because neuronal (parasympathetic nerve) and non-neuronal acetylcholine play a significant role for the bladder function. In this review, we will highlight basic and clinical aspects of eight antimuscarinic agents (oxybutynin, propiverine, tolterodine, solifenacin, darifenacin, trospium, imidafenacin, and fesoterodine) clinically used to treat urinary dysfunction in patients with OAB. The basic pharmacological characteristics of these eight antimuscarinic agents include muscarinic receptor subtype selectivity, functional bladder selectivity, and muscarinic receptor binding in the bladder and other tissues. The measurement of drug-receptor binding after oral administration of these agents allows for clearer understanding of bladder selectivity by the integration of pharmacodynamics and pharmacokinetics under in vivo conditions. Their central nervous system (CNS) penetration potentials are also discussed in terms of the feasibility of impairments in memory and cognitive function in elderly patients with OAB. The clinical aspects of efficacy focus on improvements in the daytime urinary frequency, nocturia, bladder capacity, the frequency of urgency, severity of urgency, number of incontinence episodes, OAB symptom score, and quality of life (QOL) score by antimuscarinic agents in patients with OAB. The safety of and adverse events caused by treatments with antimuscarinic agents such as dry mouth, constipation, blurred vision, erythema, fatigue, increased sweating, urinary retention, and CNS adverse events are discussed. A dose-dependent relationship was observed with adverse events, because the risk ratio generally increased with elevations in the drug dose of antimuscarinic agents. Side effect profiles may be additive to or contraindicated by other medications.
Collapse
|
17
|
Moga DC, Wu Q, Doshi P, Goodin AJ. An investigation of factors predicting the type of bladder antimuscarinics initiated in Medicare nursing homes residents. BMC Geriatr 2017; 17:295. [PMID: 29282013 PMCID: PMC5745609 DOI: 10.1186/s12877-017-0690-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background To examine factors predicting type of bladder antimuscarinics (BAM) initiated in nursing home (NH) residents. Methods Incident BAM initiators following NH admission were identified by constructing a retrospective cohort from Medicare files and Minimum Data Set (MDS). Participants included all residents 65 years and older admitted in Medicare-certified NH between January 1, 2007 and December 31, 2008 who were prescribed BAM and had continuous Medicare (Part A, B, and D) enrollment. Patient characteristics, medications, and comorbidities were derived from Medicare enrollment and claims. NH characteristics and health status were derived from MDS assessments. The outcome was defined as type of BAM initiated after admission (selective, non-selective extended release, non-selective immediate release). Multinomial logistic regression using generalized estimating equation methodology determined which factors predicted the type of BAM initiated. Results Twelve thousand eight hundred ninety-nine NH residents initiating BAM therapy were identified; 13.38% of new users were prescribed selective BAM, 45.56% non-selective extended release, and 41.07% non-selective immediate release medications. In both sexes, significant predictors of BAM included region of nursing home, body mass index, cognitive performance score, frailty measures, activities of daily living, and measures of bladder continence. In women, history of fracture and fall-related injuries were significant predictors of type of BAM use, while race and indicators of balance were significant predictors of type of BAM use in men. Non-pharmacological continence management strategies were not predictive of type of BAM initiation. Conclusions Several factors are important in predicting type of BAM initiation in both women and men, but other factors are sex-specific. Some observed factors predicting the type of BAM initiated, such as other medications use, body mass index, or provider-related factors are potentially modifiable and could be used in targeted interventions to help optimize BAM use in this population. Trial registration Not applicable. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0690-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniela C Moga
- Department of Pharmacy Practice and Science, College of Pharmacy; Department of Epidemiology, College of Public Health; Sanders-Brown Center on Aging; Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, 789 S Limestone Street, Room 241, Lexington, KY, 40536, USA.
| | - Qishan Wu
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Pratik Doshi
- Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Amie J Goodin
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| |
Collapse
|
18
|
Martin-Cano FE, Caso-Agundez M, Camello-Almaraz C, Santos FJ, Espin MT, Madrid JA, Diez-Perez A, Camello PJ, Pozo MJ. Octodon degus, a new model to study the agonist and plexus-induced response in the urinary bladder. J Physiol Biochem 2016; 73:77-87. [PMID: 27738973 DOI: 10.1007/s13105-016-0527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/03/2016] [Indexed: 01/17/2023]
Abstract
Urinary bladder function consists in the storage and controlled voiding of urine. Translational studies require animal models that match human characteristics, such as Octodon degus, a diurnal rodent. This study aims to characterize the contractility of the detrusor muscle and the morphology and code of the vesical plexus from O. degus. Body temperature was measured by an intra-abdominal sensor, the contractility of detrusor strips was evaluated by isometric tension recording, and the vesical plexus was studied by electrical field stimulation (EFS) and immunofluorescence. The animals showed a diurnal chronotype as judged from core temperature. The myogenic contractile response of the detrusor muscle to increasing doses of KCl reached its maximum (31.04 mN/mm2) at 60 mM. In the case of cumulative dose-response of bethanecol, the maximum response (37.42 mN/mm2) was reached at 3.2 × 10-4 M. The response to ATP was clearly smaller (3.8 mN/mm2). The pharmacological dissection of the EFS-induced contraction identified ACh and sensory fibers as the main contributors to this response. The neurons of the vesical plexus were located mainly in the trigone area, grouped in big and small ganglia. Out of them, 48.1 % of the neurons were nitrergic and 62.7 % cholinergic. Our results show functional and morphological similarities between the urinary bladder of O. degus and that of humans.
Collapse
Affiliation(s)
- Francisco Eduardo Martin-Cano
- Department of Physiology, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003, Caceres, Spain
| | - Mercedes Caso-Agundez
- Department of Physiology, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003, Caceres, Spain
| | - Cristina Camello-Almaraz
- Department of Physiology, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003, Caceres, Spain
| | | | - María Teresa Espin
- Digestive Surgery Service, "Infanta Cristina" Hospital, 06006, Badajoz, Spain
| | - Juan Antonio Madrid
- Chronobiology Laboratory, College of Biology, University of Murcia, IMIB-Arrixaca, 30100, Murcia, Spain
| | - Adolfo Diez-Perez
- Musculoskeletal research group, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), ISCIII, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Pedro Javier Camello
- Department of Physiology, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003, Caceres, Spain
| | - Maria Jose Pozo
- Department of Physiology, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003, Caceres, Spain.
| |
Collapse
|
19
|
Osman NI, Aldamanhori R, Mangera A, Chapple CR. Antimuscarinics, β-3 Agonists, and Phosphodiesterase Inhibitors in the Treatment of Male Lower Urinary Tract Symptoms. Urol Clin North Am 2016; 43:337-49. [DOI: 10.1016/j.ucl.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
20
|
Ehrhardt A, Wang B, Yung AC, Wang Y, Kozlowski P, van Breemen C, Schrader JW. Urinary Retention, Incontinence, and Dysregulation of Muscarinic Receptors in Male Mice Lacking Mras. PLoS One 2015; 10:e0141493. [PMID: 26516777 PMCID: PMC4627820 DOI: 10.1371/journal.pone.0141493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022] Open
Abstract
Here we show that male, but not female mice lacking expression of the GTPase M-Ras developed urinary retention with distention of the bladder that exacerbated with age but occurred in the absence of obvious anatomical outlet obstruction. There were changes in detrusor morphology in Mras-/- males: Smooth muscle tissue, which exhibited a compact organization in WT mice, appeared disorganized and became increasingly ‘layered’ with age in Mras-/- males, but was not fibrotic. Bladder tissue near the apex of bladders of Mras-/- males exhibited hypercontractility in response to the cholinergic agonist carbachol in in vitro, while responses in Mras-/- females were normal. In addition, spontaneous phasic contractions of detrusors from Mras-/- males were increased, and Mras-/- males exhibited urinary incontinence. We found that expression of the muscarinic M2 and M3 receptors that mediate the cholinergic contractile stimuli of the detrusor muscle was dysregulated in both Mras-/- males and females, although only males exhibited a urinary phenotype. Elevated expression of M2R in young males lacking M-Ras and failure to upregulate M3R with age resulted in significantly lower ratios of M3R/M2R expression that correlated with the bladder abnormalities. Our data suggests that M-Ras and M3R are functionally linked and that M-Ras is an important regulator of male bladder control in mice. Our observations also support the notion that bladder control is sexually dimorphic and is regulated through mechanisms that are largely independent of acetylcholine signaling in female mice.
Collapse
MESH Headings
- Acetylcholine/physiology
- Aging/genetics
- Aging/physiology
- Animals
- Female
- Gene Expression Regulation
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Monomeric GTP-Binding Proteins/deficiency
- Monomeric GTP-Binding Proteins/genetics
- Monomeric GTP-Binding Proteins/physiology
- Muscle Contraction
- Muscle, Smooth/metabolism
- Phenotype
- Proteinuria/genetics
- Proteinuria/physiopathology
- RNA, Messenger/biosynthesis
- Receptor, Muscarinic M2/biosynthesis
- Receptor, Muscarinic M2/genetics
- Receptor, Muscarinic M2/physiology
- Receptor, Muscarinic M3/biosynthesis
- Receptor, Muscarinic M3/genetics
- Receptor, Muscarinic M3/physiology
- Sex Characteristics
- Urinary Bladder/metabolism
- Urinary Bladder/pathology
- Urinary Bladder, Overactive/genetics
- Urinary Bladder, Overactive/physiopathology
- Urinary Incontinence/genetics
- Urinary Incontinence/physiopathology
- Urinary Retention/genetics
- Urinary Retention/physiopathology
- Urination/physiology
- ras Proteins
Collapse
Affiliation(s)
- Annette Ehrhardt
- The Biomedical Research Centre, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Bin Wang
- The Biomedical Research Centre, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Andrew C. Yung
- The University of British Columbia MRI Research Centre, Life Sciences Centre, 2350 Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Yanni Wang
- The Biomedical Research Centre, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Piotr Kozlowski
- The University of British Columbia MRI Research Centre, Life Sciences Centre, 2350 Health Sciences Mall, Vancouver, British Columbia, Canada
- The University of British Columbia, Departments of Radiology and Urologic Sciences, 818 West 10th Ave., Vancouver, British Columbia, Canada
| | - Cornelis van Breemen
- The University of British Columbia, Department of Pharmacology and Therapeutics, 2176 Health Sciences Mall, Vancouver, British Columbia, Canada
| | - John W. Schrader
- The Biomedical Research Centre, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada
- * E-mail:
| |
Collapse
|
21
|
Complementary Alternative Medicine and Therapies for Overactive Bladder Symptoms: Is There Evidence for Benefit? CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Cipullo LM, Zullo F, Cosimato C, Di Spiezio Sardo A, Troisi J, Guida M. Pharmacological Treatment of Urinary Incontinence. Female Pelvic Med Reconstr Surg 2014; 20:185-202. [DOI: 10.1097/spv.0000000000000076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
23
|
Abstract
Overactive bladder (OAB) is a symptom complex of urinary frequency, nocturia and urgency with or without urgency incontinence that adversely impacts patient's quality of life. Conservative management begins in the outpatient clinic, often with significant improvement and patient satisfaction. In this review we will discuss the evaluation of OAB and review treatment options focusing on behavioral modification, medical therapy, and neuromodulation. These treatment options are offered in a stepwise fashion, remembering that more than one may be needed and can be used concomitantly.
Collapse
|
24
|
Zacche MM, Giarenis I, Cardozo L. Phase II drugs that target cholinergic receptors for the treatment of overactive bladder. Expert Opin Investig Drugs 2014; 23:1365-74. [PMID: 24899225 DOI: 10.1517/13543784.2014.925877] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a term used to describe the symptom syndrome of urgency, with or without urgency incontinence, usually associated with frequency and nocturia. Antimuscarinics are the most widely prescribed class of drugs for OAB, although their systemic adverse effects limit their use in clinical practice as compliance. This has led to developments in the field. AREAS COVERED In this review, the authors describe Phase II drugs that target cholinergic receptors. First, the authors present the new antimuscarinics (tarafenacin and afacifenacin). This is followed by reports on a combination drug (tolenix) containing a muscarinic antagonist (tolterodine) associated with a muscarinic agonist (pilocarpine). Further, the authors discuss the trials of well-known drugs in either new combination therapy (solifenacin and mirabegron) or with new routes of delivery (oxybutynin vaginal ring). Finally, the authors examine the option of targeting nicotinic acetylcholine receptors (dexmecamylamine). EXPERT OPINION Different strategies have been adopted to improve the efficacy and tolerability of therapeutics for OAB. Nicotinic receptors represent a novel therapeutic target; however, it is unlikely that antimuscarinic agents will be replaced as standard first-line therapy in the near future.
Collapse
Affiliation(s)
- Martino Maria Zacche
- King's College Hospital, Department of Urogynaecology , Denmark Hill, SE5 9 RS, London , UK
| | | | | |
Collapse
|
25
|
Kirschstein T, Protzel C, Porath K, Sellmann T, Köhling R, Hakenberg OW. Age-dependent contribution of Rho kinase in carbachol-induced contraction of human detrusor smooth muscle in vitro. Acta Pharmacol Sin 2014; 35:74-81. [PMID: 24122009 DOI: 10.1038/aps.2013.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/12/2013] [Indexed: 01/15/2023] Open
Abstract
AIM Activation of muscarinic receptors on the detrusor smooth muscle is followed by contraction, which involves both myosin light chain kinase (MLCK) and Rho kinase (ROCK). The aim of this study was to determine the relative contributions of MLCK and ROCK to carbachol-induced contraction of human detrusor smooth muscle in vitro. METHODS Detrusor smooth muscle strips were prepared from the macroscopically unaffected bladder wall of patients underwent cystectomy. The strips were fixed in an organ bath, and carbachol or KCl-induced isometric contractions were measured by force transducers. RESULTS Addition of carbachol (0.4-4 μmol/L) into the bath induced concentration-dependent contractions of detrusor specimens, which was completely abolished by atropine (1 μmol/L). Pre-incubation of detrusor specimens with either the MLCK inhibitor ML-9 or the ROCK inhibitors HA1100 and Y-27632 (each at 10 μmol/L) significantly blocked carbachol-induced contractions as compared to the time-control experiments. Moreover, MLCK and ROCK inhibition were equally effective in reducing carbachol-induced contractions. The residual carbachol-induced contractions in the presence of both MLCK and ROCK inhibitors were significantly smaller than the contractions obtained when only one enzyme (either MLCK or ROCK) was inhibited, suggesting an additive effect of the two kinases. Interestingly, ROCK-mediated carbachol-induced contractions were positively correlated to the age of patients (r=o.52, P<0.05). CONCLUSION Both MLCK and ROCK contribute to carbachol-induced contractions of human detrusor smooth muscle. ROCK inhibitors may be a new pharmacological approach to modulate human bladder hyperactivity.
Collapse
|
26
|
Bahadory F, Moore KH, Liu L, Burcher E. Gene expression of muscarinic, tachykinin, and purinergic receptors in porcine bladder: comparison with cultured cells. Front Pharmacol 2013; 4:148. [PMID: 24348420 PMCID: PMC3842897 DOI: 10.3389/fphar.2013.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/10/2013] [Indexed: 12/04/2022] Open
Abstract
Urothelial cells, myofibroblasts, and smooth muscle cells are important cell types contributing to bladder function. Multiple receptors including muscarinic (M3/M5), tachykinin (NK1/NK2), and purinergic (P2X1/P2Y6) receptors are involved in bladder motor and sensory actions. Using female pig bladder, our aim was to differentiate between various cell types in bladder by genetic markers. We compared the molecular expression pattern between the fresh tissue layers and their cultured cell counterparts. We also examined responses to agonists for these receptors in cultured cells. Urothelial, suburothelial (myofibroblasts), and smooth muscle cells isolated from pig bladder were cultured (10–14 days) and identified by marker antibodies. Gene (mRNA) expression level was demonstrated by real-time PCR. The receptor expression pattern was very similar between suburothelium and detrusor, and higher than urothelium. The gene expression of all receptors decreased in culture compared with the fresh tissue, although the reduction in cultured urothelial cells appeared less significant compared to suburothelial and detrusor cells. Cultured myofibroblasts and detrusor cells did not contract in response to the agonists acetylcholine, neurokinin A, and β,γ-MeATP, up to concentrations of 0.1 and 1 mM. The significant reduction of M3, NK2, and P2X1 receptors under culture conditions may be associated with the unresponsiveness of cultured suburothelial and detrusor cells to their respective agonists. These results suggest that under culture conditions, bladder cells lose the receptors that are involved in contraction, as this function is no longer required. The study provides further evidence that cultured cells do not necessarily mimic the actions exerted by intact tissues.
Collapse
Affiliation(s)
- Forough Bahadory
- Department of Pharmacology, School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| | - Kate H Moore
- Detrusor Muscle Laboratory, St. George Hospital, University of New South Wales Kogarah, NSW, Australia
| | - Lu Liu
- Department of Pharmacology, School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| | - Elizabeth Burcher
- Department of Pharmacology, School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| |
Collapse
|
27
|
Yeo EKS, Hashim H, Abrams P. New therapies in the treatment of overactive bladder. Expert Opin Emerg Drugs 2013; 18:319-37. [PMID: 23885696 DOI: 10.1517/14728214.2013.823156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common condition which affects both men and women across many age groups with significant impact on quality of life. There is currently an armamentarium of treatment options available ranging from conservative, medical therapy to radical surgeries. Increasing understanding of OAB is resulting in the rapid development of new therapies today. AREAS COVERED The purpose of this article was to summarise the latest developments in non-neurogenic OAB treatment, discuss the evidence and results of current and new treatment modalities available through review of published data and results presented at recent international meetings. EXPERT OPINION The ultimate goal in OAB therapy is to provide good clinical efficacy, safe, non-invasive and easy to administer. There is definitely room for development of new therapies in OAB and current progress is encouraging.
Collapse
|
28
|
Dayanc M, Kibar Y, Ural AU, Onguru O, Yildiz O, Irkilata HC, Avcu F, Soner BC, Ulku C, Seyrek M. The histopathologic, pharmacologic and urodynamic results of mesenchymal stem cell's injection into the decompensated rabbit's bladder. Stem Cell Rev Rep 2013; 8:1245-53. [PMID: 22736388 DOI: 10.1007/s12015-012-9393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We researched the survival of bone marrow-derived mesenchymal stem cells (MSCs) and the results of MSCs' injected into decompensated bladders in a rabbit model. METHODS Partial bladder neck obstruction (PBNO) and subsequent decompensation of the bladder was achieved by wrapping the bladder neck with autologous rectus fascia. In the first aspect of the experiment 18 rabbits underwent MSC injection into the decompensated bladder to prove the survivability of injected MSCs. For this purpose MSCs were isolated, transfected with Green Fluorescent Protein (GFP), and injected into the detrusor layer. Once viability was assessed in the first phase, an additional 10 rabbits underwent PBNO in the second phase. Five of these animals underwent subsequent MSC injection (group 3, stem cell) and 5 did not (group 2, obstruction). Both groups were compared to 5 controls (group 1). Urodynamics were performed in all groups. After the animals were sacrificed the groups were compared via morphometric analysis, contractile response to carbachol and KCl, and muscarinic receptor type analysis. RESULTS On morphometric analysis, collagenous area rates were 43, 53 and 37% in group 1, 2 and 3, respectively. There was no statistically significant difference between groups in terms of bladder weight, bladder capacity and vesical pressure. The contractile effects of KCl and muscarinic agonist carbachol were significantly higher in groups 1 and 3 than group 2. The response to carbachol was antagonized by muscarinic M(1) and M(3) receptor antagonist pirenzepine and abolished by muscarinic M(3) receptor antagonist 4-DAMP in all groups. CONCLUSIONS The injection of MSCs decreased the collagenous area, increased detrusor contractility. Functional M(3) receptors were also expressed in MSCs-injected bladder smooth muscle as well as in control group.
Collapse
Affiliation(s)
- Murat Dayanc
- Department of Urology, Gulhane Military Medical Academy, Etlik, 06010 Ankara, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Ochodnicky P, Uvelius B, Andersson KE, Michel MC. Autonomic nervous control of the urinary bladder. Acta Physiol (Oxf) 2013; 207:16-33. [PMID: 23033838 DOI: 10.1111/apha.12010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/28/2011] [Accepted: 09/10/2012] [Indexed: 01/25/2023]
Abstract
The autonomic nervous system plays an important role in the regulation of the urinary bladder function. Under physiological circumstances, noradrenaline, acting mainly on β(3) -adrenoceptors in the detrusor and on α(1) (A) -adrenoceptors in the bladder outflow tract, promotes urine storage, whereas neuronally released acetylcholine acting mainly on M(3) receptors promotes bladder emptying. Under pathophysiological conditions, however, this system may change in several ways. Firstly, there may be plasticity at the levels of innervation and receptor expression and function. Secondly, non-neuronal acetylcholine synthesis and release from the urothelium may occur during the storage phase, leading to a concomitant exposure of detrusor smooth muscle, urothelium and afferent nerves to acetylcholine and noradrenaline. This can cause interactions between the adrenergic and cholinergic system, which have been studied mostly at the post-junctional smooth muscle level until now. The implications of such plasticity are being discussed.
Collapse
Affiliation(s)
- P. Ochodnicky
- Department of Pharmacology & Pharmacotherapy; Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | - B. Uvelius
- Department of Urology; Skane University Hospital; Malmö; Sweden
| | - K.-E. Andersson
- Institute for Regenerative Medicine; Wake Forest University School of Medicine; Winston Salem; NC; USA
| | - M. C. Michel
- Department of Pharmacology; Johannes Gutenberg University; Mainz; Germany
| |
Collapse
|
30
|
Abstract
Overactive bladder is a debilitating disorder affecting 16.5% of adults and increasing in prevalence with age. Symptoms, including urgency, urge incontinence and frequency can result from detrusor overactivity with contraction of the bladder mediated primarily by activation of muscarinic M(3) receptors. Antimuscarinic agents are therefore an important approach to treating overactive bladder, but a lack of M(3) receptor subtype selectivity with these agents can generate a range of side effects that limits their effectiveness. This review describes an alternative approach to treating overactive bladder using the selective muscarinic M(3) receptor antagonist darifenacin. The M(3) receptor selectivity of darifenacin improves the symptoms of overactive bladder while reducing the potential for deleterious effects of non-M(3) muscarinic receptor antagonism in the brain or heart. The pharmacology and pharmacokinetics of darifenacin are summarized, and the its clinical efficacy and demonstrated safety profile are described.
Collapse
Affiliation(s)
- François Haab
- Départment d'Urologie, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France.
| |
Collapse
|
31
|
Pramanik C, Bapat K, Chaudhari A, Tripathy NK, Gurjar MK. A New Solvent System (Cyclopentyl Methyl Ether–Water) in Process Development of Darifenacin HBr. Org Process Res Dev 2012. [DOI: 10.1021/op300119s] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Chinmoy Pramanik
- API R&D Centre, Emcure Pharmaceuticals Ltd., ITBT Park, Phase-II, MIDC, Hinjewadi, Pune-411057, India
| | - Kiran Bapat
- API R&D Centre, Emcure Pharmaceuticals Ltd., ITBT Park, Phase-II, MIDC, Hinjewadi, Pune-411057, India
| | - Ashok Chaudhari
- API R&D Centre, Emcure Pharmaceuticals Ltd., ITBT Park, Phase-II, MIDC, Hinjewadi, Pune-411057, India
| | - Narendra K. Tripathy
- API R&D Centre, Emcure Pharmaceuticals Ltd., ITBT Park, Phase-II, MIDC, Hinjewadi, Pune-411057, India
| | - Mukund K. Gurjar
- API R&D Centre, Emcure Pharmaceuticals Ltd., ITBT Park, Phase-II, MIDC, Hinjewadi, Pune-411057, India
| |
Collapse
|
32
|
Grimshaw R, Jain P, Latthe P. Management of mixed urinary incontinence. WOMENS HEALTH 2012; 8:567-77. [PMID: 22934730 DOI: 10.2217/whe.12.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mixed urinary incontinence accounts for 33% of all incontinence and is the involuntary loss of urine associated with the sensation of urgency; it is also associated with exertion, sneezing or coughing. Risk factors include vaginal delivery, obesity, age and possible genetic factors. Treatment includes lifestyle changes, behavioral therapies, medication and nerve modulation. Surgery with midurethral slings can cure both stress and urge components in 40-50% of cases. Future therapies may include new medications adapting potassium and calcium channels and more widespread use of sacral neuromodulation. This review focuses on the investigation and optimal management of mixed urinary incontinence.
Collapse
Affiliation(s)
- Rosamund Grimshaw
- Department of Obstetrics & Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK.
| | | | | |
Collapse
|
33
|
Zhang S, Lv JW, Yang P, Yu Q, Pang J, Wang Z, Guo H, Liu S, Hu J, Li J, Leng J, Huang Y, Ye Z, Wang CY. Loss of dicer exacerbates cyclophosphamide-induced bladder overactivity by enhancing purinergic signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:937-46. [PMID: 22796409 DOI: 10.1016/j.ajpath.2012.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/30/2012] [Indexed: 12/23/2022]
Abstract
microRNAs (miRNAs) have regulated the expression and function of genes implicated in many pathological settings, but their impact on the pathoetiological characteristics of overactive bladder (OAB) largely remains unknown. We have generated a mouse model in which adult mice can be induced for detrusor deletion of Dicer, an enzyme essential for miRNA processing. Targeted deletion of Dicer did not lead to a significant change for detrusor functionality under physiological conditions; however, loss of Dicer exacerbated cyclophosphamide-induced OAB, manifested by the higher severity of altered detrusor contractile force and sensitivity, abnormal urodynamics, and enhanced macrophage infiltration. Mechanistic studies revealed that loss of Dicer may impair the expression of miRNAs that are capable of targeting P2x mRNAs. As a result, mice deficient in Dicer manifest enhanced P2X expression in the detrusor on cyclophosphamide treatment, predisposing to the increased risk for OAB development. More important, studies using bladder biopsy samples of patients with OAB also demonstrated similar results as those found in animals. Taken together, our results suggest that miRNAs modulate OAB susceptibility by regulating purinergic signaling, in which the pathogenic insult induces the expression of miRNAs capable of targeting P2X mRNAs to suppress OAB symptoms.
Collapse
Affiliation(s)
- Shu Zhang
- The Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Shahab N, Kajioka S, Seki N, Naito S. Functional Role of Muscarinic Receptor Subtypes in Calcium Sensitization and Their Contribution to Rho-kinase and Protein Kinase C Pathways in Contraction of Human Detrusor Smooth Muscle. Urology 2012; 79:1184.e7-13. [DOI: 10.1016/j.urology.2011.11.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/10/2011] [Accepted: 11/29/2011] [Indexed: 12/21/2022]
|
35
|
Abstract
Voiding of the bladder is the result of a parasympathetic muscarinic receptor activation of the detrusor smooth muscle. However, the maintenance of continence and a normal bladder micturition cycle involves a complex interaction of cholinergic, adrenergic, nitrergic and peptidergic systems that is currently little understood. The cholinergic component of bladder control involves two systems, acetylcholine (ACh) released from parasympathetic nerves and ACh from non-neuronal cells within the urothelium. The actions of ACh on the bladder depend on the presence of muscarinic receptors that are located on the detrusor smooth muscle, where they cause direct (M₃) and indirect (M₂) contraction; pre-junctional nerve terminals where they increase (M₁) or decrease (M₄) the release of ACh and noradrenaline (NA); sensory nerves where they influence afferent nerve activity; umbrella cells in the urothelium where they stimulate the release of ATP and NO; suburothelial interstitial cells with unknown function; and finally, other unidentified sites in the urothelium from where prostaglandins and inhibitory/relaxatory factors are released. Thus, the actions of muscarinic receptor agonists and antagonists on the bladder may be very complex even when considering only local muscarinic actions. Clinically, muscarinic antagonists remain the mainstay of treatment for the overactive bladder (OAB), while muscarinic agonists have been used to treat hypoactive bladder. The antagonists are effective in treating OAB, but their precise mechanisms and sites of action (detrusor, urothelium, and nerves) have yet to be established. Potentially more selective agents may be developed when the cholinergic systems within the bladder are more fully understood.
Collapse
|
36
|
Pathophysiology of overactive bladder. Int Urogynecol J 2012; 23:975-82. [PMID: 22310925 DOI: 10.1007/s00192-012-1682-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 01/16/2012] [Indexed: 01/01/2023]
Abstract
Overactive bladder (OAB) is a common disorder that negatively affects the quality of life of our patients and carries a large socioeconomic burden. According to the International Continence Society, it is characterized as urinary urgency, with or without urge incontinence, usually, with frequency and nocturia in the absence of causative infection. The pathophysiology of this disease entity varies between neurogenic, myogenic, or idiopathic factors. This paper provides a review of the contemporary theories behind the pathophysiology of OAB.
Collapse
|
37
|
Mangera A, Chapple CR. Summary of Anticholinergic Pharmacotherapy Available for Overactive Bladder Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0114-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
38
|
Urothelial/Lamina Propria Spontaneous Activity and the Role of M3 Muscarinic Receptors in Mediating Rate Responses to Stretch and Carbachol. Urology 2011; 78:1442.e9-15. [DOI: 10.1016/j.urology.2011.08.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 07/10/2011] [Accepted: 08/18/2011] [Indexed: 11/22/2022]
|
39
|
Owen SJ, Rose'Meyer RB, Massa HM. Dietary phytoestrogens maintain contractile responses to carbachol with age in the female rat isolated bladder. Life Sci 2011; 89:213-20. [PMID: 21718707 DOI: 10.1016/j.lfs.2011.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/08/2011] [Accepted: 05/19/2011] [Indexed: 11/26/2022]
Abstract
AIMS Development of urinary incontinence, for many women, occurs following menopause. Dietary phytoestrogens consumed over the long term may affect the contractile function and maintenance of the urinary bladder in post menopausal women. This study examined the muscarinic receptor mediated contractile responses in the rat isolated bladder in response to ovariectomy and long term dietary phytoestrogen consumption. MAIN METHODS Ovariectomised or sham-operated female Wistar rats (8 weeks) were fed either normal rat chow (soy, phytoestrogens) or a non-soy (phytoestrogen free) diet. Bladders were dissected from rats at 12, 24 and 52 weeks of age and placed in 25 ml organ baths filled with McEwans solution. KEY FINDINGS The contractile response to carbachol, in 12 week old female rats did not change as a result of dietary phytoestrogens or ovariectomy (P>0.05). At 24 weeks of age, detrusor muscle strip responses to carbachol from non-soy fed ovariectomised rats were attenuated (P<0.05). At 52 weeks, bladder detrusor strip responses to carbachol were reduced in all treatment groups with the exception of the soy-fed sham operated rats. SIGNIFICANCE These results suggest an age-related reduction in the contractile response of the detrusor to the muscarinic receptor agonist carbachol, which may be prevented by long term dietary phytoestrogen intake.
Collapse
Affiliation(s)
- Suzzanne J Owen
- School of Medical Sciences, Griffith University, Gold Coast Campus, Queensland, 4222, Australia
| | | | | |
Collapse
|
40
|
Glavind K, Chancellor M. Antimuscarinics for the treatment of overactive bladder: understanding the role of muscarinic subtype selectivity. Int Urogynecol J 2011; 22:907-17. [PMID: 21468739 DOI: 10.1007/s00192-011-1411-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/10/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Antimuscarinic agents appear to exert their therapeutic activity in overactive bladder (OAB) via blockade of the M(3) muscarinic receptor subtype. Antimuscarinics are broadly similar in efficacy, but their safety and tolerability profiles vary, which may reflect differences in muscarinic receptor selectivity profiles. METHODS This review of available literature aims to determine whether antimuscarinic agents with greater M(3) selectivity have clinical advantages over less selective drugs. RESULTS Antimuscarinic agents differ widely in their propensity to cause cognitive and cardiovascular (CV) effects, which appear mainly to be related to differences in their relative selectivity for binding to non-M(3) receptors, including M(1) receptors in the brain and cardiac M(2) receptors. CONCLUSIONS Cognitive and CV effects are especially pertinent for the OAB patient who tends to be older with various comorbidities and is often taking multiple medications. Hence, it is important to consider the risk/benefit balance of antimuscarinic agents when selecting OAB treatment.
Collapse
Affiliation(s)
- Karin Glavind
- Department of Gynecology and Obstetrics, Aalborg Sygehus Nord, 9000 Aalborg, Denmark.
| | | |
Collapse
|
41
|
Zhou J, Luan GD, Ren LM, Wu ZG, Wang X, Zhao Y. Pharmacologic characteristics of bladder micturition function in anesthetized mice. Comp Med 2010; 60:436-442. [PMID: 21262129 PMCID: PMC3002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/04/2010] [Accepted: 06/29/2010] [Indexed: 05/30/2023]
Abstract
In the present study, we observed the effects of an α(1)-adrenoceptor agonist (phenylephrine), β-adrenoceptor agonist (isoprenaline), muscarinic cholinoceptor agonist (carbachol), and α(1)-adrenoceptor antagonist (doxazosin) on the bladder micturition function in anesthetized mice. Changes in bladder pressure in response to filling and blood pressure were recorded by using a data acquisition system. Phenylephrine (50 to 800 μg/kg) increased vesical micturition pressure in a dose-dependent manner but increased micturition basal pressure only at 800 μg/kg. Carbachol (3 to 7 μg/kg) increased the intercontraction interval and micturition time in a dose-dependent manner but increased micturition basal pressure only at 7 μg/kg. Isoprenaline (10 to 1000 μg/kg) increased micturition time and decreased vesical micturition pressure in a dose-dependent manner. Doxazosin (10 to 1000 μg/kg) did not affect bladder micturition function but dose-dependently inhibited phenylephrine-induced increases in vesical micturition pressure. Carbachol (7 μg/kg) and isoprenaline (1 mg/kg) caused a transient fall in blood pressure, whereas doxazosin (1 mg/kg) had a long-lasting hypotensive effect. The maximal decrease in systolic and mean blood pressure by carbachol did not differ from that by doxazosin and isoprenaline, respectively. Phenylephrine (800 μg/kg) transiently increased the blood pressure of anesthetized mice. These results indicate that activation of muscarinic cholinoceptors decreases voiding frequency and increases bladder capacity in anesthetized mice. Activation of α(1)-adrenoceptors mainly increases vesical micturition pressure, whereas activation of β-adrenoceptors decreases vesical micturition pressure and prolongs micturition time in anesthetized mice.
Collapse
|
42
|
Sinha S, Gupta S, Malhotra S, Krishna NS, Meru AV, Babu V, Bansal V, Garg M, Kumar N, Chugh A, Ray A. AE9C90CB: a novel, bladder-selective muscarinic receptor antagonist for the treatment of overactive bladder. Br J Pharmacol 2010; 160:1119-27. [PMID: 20590605 DOI: 10.1111/j.1476-5381.2010.00752.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE AE9C90CB (N- [(1R, 5S, 6R)-3-azabicyclo [3.1.0] hex-6-ylmethyl]-2-hydroxy-N-methyl-2, 2-diphenylacetamide), a novel muscarinic receptor antagonist, was synthesized for the treatment of overactive bladder. Here we describe the in vitro and in vivo profiles of AE9C90CB for action in bladder over salivary gland and compare it with four agents already in clinical use (tolterodine, oxybutynin, solifenacin and darifenacin). EXPERIMENTAL APPROACH Radioligand binding assay and isolated tissue-based functional assay were used to evaluate affinity, potency, and receptor subtype selectivity of compounds. Inhibition of carbachol-induced increase in intravesicular pressure and salivary secretion were measured in anaesthetized rabbits to assess the functional selectivity. KEY RESULTS In vitro radioligand binding study using human recombinant muscarinic receptors showed that AE9C90CB had greater affinity for M(3) muscarinic receptors with pKi of 9.90 +/- 0.11 and was 20-fold more selective for M(3) than for M(2) muscarinic receptors. AE9C90CB exhibited an unsurmountable antagonism on rat bladder strips (pK(B), 9.13 +/- 0.12). In anaesthetized rabbits after intravenous administration, AE9C90CB dose dependently inhibited carbachol-induced increase in intravesicular pressure and salivary secretion, and exhibited functional selectivity for urinary bladder over salivary gland which was ninefold better than that of oxybutynin. CONCLUSIONS AND IMPLICATIONS We have identified AE9C90CB, a compound exhibiting moderate selectivity for M(3) over M(2) receptors but greater selectivity for urinary bladder over salivary gland than oxybutynin, tolterodine, solifenacin and darifenacin. Therefore, AE9C90CB may be a promising compound for the treatment of overactive bladder with reduced potential to cause dry mouth than currently available antimuscarinic drugs.
Collapse
Affiliation(s)
- S Sinha
- Department of Pharmacology, Ranbaxy Laboratories Ltd., Gurgaon, Haryana, India
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Nausch B, Heppner TJ, Nelson MT. Nerve-released acetylcholine contracts urinary bladder smooth muscle by inducing action potentials independently of IP3-mediated calcium release. Am J Physiol Regul Integr Comp Physiol 2010; 299:R878-88. [PMID: 20573989 DOI: 10.1152/ajpregu.00180.2010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Nerve-released ACh is the main stimulus for contraction of urinary bladder smooth muscle (UBSM). Here, the mechanisms by which ACh contracts UBSM are explored by determining Ca(2+) and electrical signals induced by nerve-released ACh. Photolysis of caged inositol 1,4,5-trisphosphate (IP(3)) evoked Ca(2+) release from the sarcoplasmic reticulum. Electrical field stimulation (20 Hz) induced Ca(2+) waves within the smooth muscle that were present only during stimulus application. Ca(2+) waves were blocked by inhibition of muscarinic ACh receptors (mAChRs) with atropine and depletion of sarcoplasmic reticulum Ca(2+) stores with cyclopiazonic acid (CPA), and therefore likely reflect activation of IP(3) receptors (IP(3)Rs). Electrical field stimulation also increased excitability to induce action potentials (APs) that were accompanied by Ca(2+) flashes, reflecting Ca(2+) entry through voltage-dependent Ca(2+) channels (VDCCs) during the action potential. The evoked Ca(2+) flashes and APs occurred as a burst with a lag time of approximately 1.5 s after onset of stimulation. They were not inhibited by blocking IP(3)-mediated Ca(2+) waves, but by blockers of mAChRs (atropine) and VDCCs (diltiazem). Nerve-evoked contractions of UBSM strips were greatly reduced by blocking VDCCs, but not by preventing IP(3)-mediated Ca(2+) signaling with cyclopiazonic acid or inhibition of PLC with U73122. These results indicate that ACh released from nerve varicosities induces IP(3)-mediated Ca(2+) waves during stimulation; but contrary to expectations, these signals do not appear to participate in contraction. In addition, our data provide compelling evidence that UBSM contractions evoked by nerve-released ACh depend on increased excitability and the resultant Ca(2+) entry through VDCCs during APs.
Collapse
Affiliation(s)
- Bernhard Nausch
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | | | | |
Collapse
|
44
|
Abstract
The succinate salt of solifenacin, a tertiary amine with anticholinergic properties, is used for symptomatic treatment of overactive bladder. Solifenacin peak plasma concentrations of 24.0 and 40.6 ng/mL are reached 3-8 hours after long-term oral administration of a 5 or 10 mg solifenacin dose, respectively. Studies in healthy adults have shown that the drug has high absolute bioavailability of about 90%, which does not decrease with concomitant food intake. Solifenacin has an apparent volume of distribution of 600 L, is 93-96% plasma protein bound, and probably crosses the blood-brain barrier. Solifenacin is eliminated mainly through hepatic metabolism via cytochrome P450 (CYP) 3A4, with about only 7% (3-13%) of the dose being excreted unchanged in the urine. Solifenacin metabolites are unlikely to contribute to clinical solifenacin effects. In healthy adults, total clearance of solifenacin amounts to 7-14 L/h. The terminal elimination half-life ranges from 33 to 85 hours, permitting once-daily administration. Urinary excretion plays a minor role in the elimination of solifenacin, resulting in renal clearance of 0.67-1.51 L/h. Solifenacin does not influence the activity of CYP1A1/2, 2C9, 2D6 and 3A4, and shows a weak inhibitory potential for CYP2C19 and P-glycoprotein in vitro; however, clinical drug-drug interactions with CYP2C19 and P-glycoprotein substrates are very unlikely. Exposure to solifenacin is increased about 1.2-fold in elderly subjects and about 2-fold in subjects with moderate hepatic and severe renal impairment, as well as by coadministration of the potent CYP3A4 inhibitor ketoconazole 200 mg/day. The full therapeutic effects of solifenacin occur after 2-4 weeks of treatment and are maintained upon long-term therapy. Although solifenacin pharmacokinetics display linearity at doses of 5-40 mg, no obvious dose dependency was observed in efficacy and tolerability studies. The efficacy of solifenacin (5 or 10 mg/day) is at least equal to that of extended-release (ER) tolterodine (4 mg/day) in reducing the mean number of micturitions per 24 hours and urgency episodes, and in increasing the volume voided per micturition. Solifenacin (5 mg/day) appears to be superior to ER tolterodine (4 mg/day) in reducing incontinence episodes (mean -1.30 vs -0.90, p = 0.018) and is superior to propiverine (20 mg/day) at the dose of 10 mg/day in reducing urgency (-2.30 vs -2.78, p = 0.012) and nocturia episodes. Based on withdrawal rates due to adverse effects during the 52-week treatment period, solifenacin appears to have better tolerability than immediate-release (IR) oxybutynin 10-15 mg/day and IR tolterodine 4 mg/day. With regard to the pharmacokinetics of solifenacin, and for safety reasons, doses exceeding 5 mg/day are not recommended for patients with moderate hepatic impairment (Child-Pugh score 7-9), patients with severe renal impairment (creatinine clearance <30 mL/min) and subjects undergoing concomitant therapy with CYP3A4 inhibitors.
Collapse
Affiliation(s)
- Oxana Doroshyenko
- Department of Pharmacology, Clinical Pharmacology Unit, University of Cologne, Cologne, Germany
| | | |
Collapse
|
45
|
Propping S, Braeter M, Grimm MO, Wirth MP, Ravens U, Wuest M. Anticholinergic effects of cis- and trans-isomers of two metabolites of propiverine. Naunyn Schmiedebergs Arch Pharmacol 2010; 381:329-38. [PMID: 20182702 DOI: 10.1007/s00210-010-0493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
Abstract
The muscarinic receptor antagonist propiverine used for therapy of overactive bladder undergoes first pass metabolism, leading to several active metabolites, which affect muscarinic receptors and L-type Ca(2+) channels with different potencies. M-5, the major metabolite in blood, and M-6 can be synthesized as cis- and trans-isomers. We systematically investigated the pharmacodynamic profiles of the isomers on detrusor contractile function. In murine and porcine detrusor, the effects of the derivatives were examined on contractions induced by electric field stimulation (EFS), cumulatively increasing concentrations of carbachol or high KCl concentration. EFS contractions were concentration-dependently reduced by the M-5 and M-6 isomers although to a different extent. M-5(cis) was slightly more potent than M-5(trans), but the differences did not reach statistical significance. M-6(cis) was significantly more potent than M-6(trans). Responses to carbachol were antagonized by all compounds due to rightward shifts of the concentration-response curves, but only M-5(trans) also significantly reduced the maximum response. pK (B) values obtained with Schild plot analysis indicated slightly higher potency for M-6(cis) than M-6(trans). Ca(2+) influx-dependent contractions elicited by K(+) depolarization were less impaired by low concentrations of the M-6 isomers, but strongly suppressed by 100 microM of the M-5 isomers, suggesting an additional effect of the two M-5 isomers on Ca(2+) influx. All investigated isomers of M-5 and M-6 are biologically active in reducing detrusor contraction in animal tissue. While M-5( cis,) M-6(cis), and M-6(trans) possess surmountable or partially surmountable antagonistic properties at muscarinic receptors, M-5(trans) is a strong non-competitive antagonist. However, at higher concentration ranges, all four compounds seem to have additional effects on Ca(2+) influx.
Collapse
Affiliation(s)
- Stefan Propping
- Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, 01307 Dresden, Germany.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Muscarinic receptors have long been the target receptors for treatment of patients with overactive bladder (OAB). These patients experience symptoms of urgency, urinary frequency and nocturia, with or without urge incontinence (the involuntary leakage of urine associated with urge). Fesoterodine, a pro-drug, structurally and functionally related to tolterodine, is the newest agent developed for the treatment of OAB. Fesoterodine is broken down to the active metabolite, 5-hydroxy-methyl-tolterodine (5-HMT) by non-specific esterases. This metabolism results in the complete breakdown of the parent compound and is responsible for dose related improvements in clinical efficacy and health related quality of life. Like other antimuscarinic agents including tolterodine, fesoterodine is associated with improvements in clinical variables related both to bladder filling (decreasing micturition frequency and increasing mean voided volume) and urgency (urgency and urge incontinence episodes). Improvements in health related quality of life following treatment with fesoterodine is indicated by improvements in 7 of the 9 variables measured by the King’s Health Questionnaire. Also like other antimuscarinic agents, fesoterodine use is associated with adverse events including dry mouth. However the incidence of dry mouth is reduced with fesoterodine, compared to oxybutynin, due to the improved bladder selectivity of 5-HMT.
Collapse
Affiliation(s)
- Kylie J Mansfield
- Graduate School of Medicine, University of Wollongong, NSW, Australia
| |
Collapse
|
47
|
Cardozo L, Chapple CR, Dmochowski R, Fitzgerald MP, Hanno P, Michel MC, Staskin D, Van Kerrebroeck P, Wyndaele JJ, Yamaguchi O, Yoshida M. Urinary urgency - translating the evidence base into daily clinical practice. Int J Clin Pract 2009; 63:1675-82. [PMID: 19930329 DOI: 10.1111/j.1742-1241.2009.02205.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To consider the currently available knowledge and understanding of the symptom of urgency. MATERIALS & METHODS Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion. RESULTS This overview summarises relevant published literature and the current clinical experience of the authors. DISCUSSION Whilst the mechanisms producing the sensation of urgency are still not fully understood and we are working within a definition that may complicate measurement and treatment, our pressing need is to effectively manage our patients for whom the practical nature of urgency can be all too apparent. CONCLUSION Health care professionals have an important role to play today in helping to alleviate the widespread problem of urgency and its consequences.
Collapse
Affiliation(s)
- L Cardozo
- King's College Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Heppner TJ, Werner ME, Nausch B, Vial C, Evans RJ, Nelson MT. Nerve-evoked purinergic signalling suppresses action potentials, Ca2+ flashes and contractility evoked by muscarinic receptor activation in mouse urinary bladder smooth muscle. J Physiol 2009; 587:5275-88. [PMID: 19736301 DOI: 10.1113/jphysiol.2009.178806] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Contraction of urinary bladder smooth muscle (UBSM) is caused by the release of ATP and ACh from parasympathetic nerves. Although both purinergic and muscarinic pathways are important to contraction, their relative contributions and signalling mechanisms are not well understood. Here, the contributions of each pathway to urinary bladder contraction and the underlying electrical and Ca(2+) signalling events were examined in UBSM strips from wild type mice and mice deficient in P2X1 receptors (P2X1(-/-)) before and after pharmacological inhibition of purinergic and muscarinic receptors. Electrical field stimulation was used to excite parasympathetic nerves to increase action potentials, Ca(2+) flash frequency, and force. Loss of P2X1 function not only eliminated action potentials and Ca(2+) flashes during stimulation, but it also led to a significant increase in Ca(2+) flashes following stimulation and a corresponding increase in the force transient. Block of muscarinic receptors did not affect action potentials or Ca(2+) flashes during stimulation, but prevented them following stimulation. These findings indicate that nerve excitation leads to rapid engagement of smooth muscle P2X1 receptors to increase action potentials (Ca(2+) flashes) during stimulation, and a delayed increase in excitability in response to muscarinic receptor activation. Together, purinergic and muscarinic stimulation shape the time course of force transients. Furthermore, this study reveals a novel inhibitory effect of P2X1 receptor activation on subsequent increases in muscarinic-driven excitability and force generation.
Collapse
Affiliation(s)
- Thomas J Heppner
- Department of Pharmacology, Given Bldg, Room C315, 89 Beaumont Avenue, University of Vermont, Burlington, VT 05405-0068, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Defects in muscarinic receptor cell signaling in bladder urothelial cancer cell lines. Urology 2009; 74:467-73. [PMID: 19573899 DOI: 10.1016/j.urology.2009.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 01/29/2009] [Accepted: 02/07/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To explore muscarinic receptor signaling in 4 bladder cancer cell lines, bladder urothelial cells (BUC) have been shown to release and respond to various putative neurotransmitters. METHODS Reverse transcription-polymerase chain reaction was used to detect the presence of m1-m5 transcripts in the J82, RT4, T24, and 5637 lines of cancer BUC. Immunofluorescence was used to detect expression of m3 protein. Cancer and normal BUC were stimulated with carbachol (100 microM), a muscarinic agonist. Carbachol-evoked changes in intracellular calcium ([Ca(2+)](i)) levels were measured using fura-2 ratiometric microfluorimetry. Transfection of J82 cells with m3 plasmid was performed, and changes in carbachol-evoked [Ca(2+)](i) were re-examined. RESULTS None of the cancer cell lines expressed m3 transcripts, unlike normal BUC, which expressed m3. None of the 4 bladder cancer cell lines responded to carbachol. However, 47% of normal BUC responded to carbachol. The m3-transfected J82 cells expressed both m3 transcript and protein. Thirteen percent of m3-transfected J82 cells responded to carbachol. CONCLUSIONS This is the first description of altered muscarinic signaling in cancer BUC. Unlike normal BUC, bladder urothelial cancer cells neither expressed m3 transcript nor responded to carbachol, as measured by changes in [Ca(2+)](i). We could partially reverse this defect in one of the cancer cell lines, J82, by transfecting these cells with the m3 plasmid. Although the effects of muscarinic receptor signaling on urothelial cell are unknown, this signaling pathway may play a role in urothelial cell adhesion similar to that in keratinocytes.
Collapse
|
50
|
Abstract
AbstractThe aim of the study was to determine pathways involved in contraction and relaxation of the mouse urinary bladder. Mouse bladder strips were set up in gassed Krebs-bicarbonate solution and responses to various drugs and electrical field stimulation were obtained. Isoprenaline (b-receptor agonist) caused a 63% inhibition of carbachol precontracted detrusor (EC50=2nM). Carbachol caused contraction (EC50=0.3µM), responses were antagonised more potently by 4-DAMP (M3-antagonist) than methoctramine (M2-antagonist). Electrical field stimulation caused contraction, which was inhibited by atropine (60%) and less by guanethidine and α,β-methylene-ATP. The neurogenic responses were not potentiated by inhibition of nitric oxide synthase. Presence of an intact urothelium significantly depressed responses to carbachol (p=0.02) and addition of indomethacin and L-NNA to remove prostaglandin and nitric oxide production respectively did not prevent the inhibitory effect of the urothelium. In conclusion, b-receptor agonists cause relaxation and muscarinic agonists cause contraction via the M3-receptor. Acetylcholine is the main neurotransmitter causing contraction while nitric oxide has a minor role. The mouse and human urothelium are similar in releasing a factor that inhibits contraction of the detrusor muscle which is unidentified but is not nitric oxide or a prostaglandin. Therefore, the mouse may be used as a model to study the lower urinary tract.
Collapse
|