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Rupniak NMJ, Fernandes S, Hou S, Thor KB, Marson L. Effect of GR205171 on autonomic dysreflexia induced by colorectal distension in spinal cord injured rats. Spinal Cord 2023; 61:499-504. [PMID: 37495714 DOI: 10.1038/s41393-023-00918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
STUDY DESIGN Preclinical pharmacology. OBJECTIVES To determine whether blocking substance P signaling attenuates the hypertension and bradycardia evoked by colorectal distension (CRD) in spinal cord injured (SCI) rats. SETTING University laboratory in Pennsylvania, U.S.A. METHODS Tachykinin NK1 receptor antagonists were administered 30 min prior to CRD three weeks after complete spinal cord transection at the 4th thoracic (T4) level. The dose range, route of administration, and pretreatment time was based on published data demonstrating occupancy of brain NK1 receptors in rodents. RESULTS Subcutaneous (SC) administration of 10-30 mg/kg GR205171 ((2S,3S)-N-[[2-methoxy-5-[5-(trifluoromethyl)tetrazol-1-yl]phenyl]methyl]-2-phenylpiperidin-3-amine dihydrochloride) reduced CRD-induced hypertension and bradycardia by 55 and 49%, respectively, compared with pretreatment values. There was no effect of GR205171 on resting blood pressure or heart rate. In contrast, the same dose range of CP-99,994 ((2S,3S)-N-[(2-methoxyphenyl)methyl]-2-phenyl-3-piperidinamine dihydrochloride) had no effect on CRD-induced cardiovascular responses. CONCLUSIONS The effective dose range of GR205171 to alleviate autonomic dysreflexia is consistent with the blockade of NK1 receptors on pelvic sensory afferents in the lumbosacral spinal cord, which may in turn prevent the over-excitation of sympathetic preganglionic neurons (SPNs) that regulate blood pressure and heart rate. The findings provide preclinical support for the utility of NK1 receptor antagonists to treat autonomic dysreflexia in people with SCI. The difference in the effects of the two NK1 receptor antagonists may reflect the ~200-fold lower affinity of CP-99,994 than GR205171 for the rat NK1 receptor.
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Affiliation(s)
- Nadia M J Rupniak
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, Durham, NC, 27709, USA.
| | - Silvia Fernandes
- Marion Murray Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Pennsylvania, PA, 19129, USA
| | - Shaoping Hou
- Marion Murray Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Pennsylvania, PA, 19129, USA
| | - Karl B Thor
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, Durham, NC, 27709, USA
| | - Lesley Marson
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, Durham, NC, 27709, USA
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Szallasi A. The Vanilloid (Capsaicin) Receptor TRPV1 in Blood Pressure Regulation: A Novel Therapeutic Target in Hypertension? Int J Mol Sci 2023; 24:8769. [PMID: 37240118 PMCID: PMC10217837 DOI: 10.3390/ijms24108769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Today's sedentary lifestyle with excess food and little exercise increases the number of people with hypertension, a major risk factor for stroke. New knowledge of treatments in this field is of utmost importance. In animal experiments, the activation by capsaicin of TRPV1-expressing sensory afferents evokes a drop in blood pressure by triggering the Bezold-Jarisch reflex. In hypertensive rats, capsaicin reduces blood pressure. Conversely, genetic ablation of the TRPV1 receptor results in elevated nocturnal (but not diurnal) blood pressure. These observations imply a therapeutic potential for TRPV1 activation in hypertensive patients. Indeed, in a major epidemiological study involving 9273 volunteers, dietary capsaicin was found to lower the risk for hypertension. New research indicates that the mechanism of action of capsaicin on blood pressure regulation is far more complex than previously thought. In addition to the well-recognized role of capsaicin-sensitive afferents in blood pressure regulation, TRPV1 seems to be expressed both in endothelial cells and vascular smooth muscle. This review aims to evaluate the therapeutic potential of TRPV1-targeting drugs in hypertensive patients.
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Affiliation(s)
- Arpad Szallasi
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
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Minic Z, O’Leary DS, Reynolds CA. Spinal Reflex Control of Arterial Blood Pressure: The Role of TRP Channels and Their Endogenous Eicosanoid Modulators. Front Physiol 2022; 13:838175. [PMID: 35283783 PMCID: PMC8904930 DOI: 10.3389/fphys.2022.838175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/26/2022] [Indexed: 01/14/2023] Open
Abstract
The spinal cord is an important integrative center for blood pressure control. Spinal sensory fibers send projections to sympathetic preganglionic neurons of the thoracic spinal cord and drive sympathetically-mediated increases in blood pressure. While these reflexes responses occur in able-bodied individuals, they are exaggerated following interruption of descending control - such as occurs following spinal cord injury. Similar reflex control of blood pressure may exist in disease states, other than spinal cord injury, where there is altered input to sympathetic preganglionic neurons. This review primarily focuses on mechanisms wherein visceral afferent information traveling via spinal nerves influences sympathetic nerve activity and blood pressure. There is an abundance of evidence for the widespread presence of this spinal reflex arch originating from virtually every visceral organ and thus having a substantial role in blood pressure control. Additionally, this review highlights specific endogenous eicosanoid species, which modulate the activity of afferent fibers involved in this reflex, through their interactions with transient receptor potential (TRP) cation channels.
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Affiliation(s)
- Zeljka Minic
- Department of Emergency Medicine Wayne State University School of Medicine, Detroit, MI, United States
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Donal S. O’Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Christian A. Reynolds
- Department of Emergency Medicine Wayne State University School of Medicine, Detroit, MI, United States
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
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Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury. Nat Commun 2021; 12:5850. [PMID: 34615867 PMCID: PMC8494794 DOI: 10.1038/s41467-021-26026-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
In children with spinal cord injury (SCI), scoliosis due to trunk muscle paralysis frequently requires surgical treatment. Transcutaneous spinal stimulation enables trunk stability in adults with SCI and may pose a non-invasive preventative therapeutic alternative. This non-randomized, non-blinded pilot clinical trial (NCT03975634) determined the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 8 children with trunk control impairment due to acquired SCI using within-subject repeated measures study design. Primary safety and efficacy outcomes (pain, hemodynamics stability, skin irritation, trunk kinematics) and secondary outcomes (center of pressure displacement, compliance rate) were assessed within the pre-specified endpoints. One participant did not complete the study due to pain with stimulation on the first day. One episode of autonomic dysreflexia during stimulation was recorded. Following hemodynamic normalization, the participant completed the study. Overall, spinal stimulation was well-tolerated and enabled upright sitting posture in 7 out of the 8 participants. Scoliosis due to trunk muscle paralysis frequently requires surgical treatment in children with spinal cord injury. The authors demonstrate the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 7/8 children with trunk control impairment in a within-subjects, repeated measures pilot clinical trial.
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Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury. BIOLOGY 2021; 10:biology10090928. [PMID: 34571804 PMCID: PMC8470244 DOI: 10.3390/biology10090928] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022]
Abstract
Simple Summary Spinal cord injury can result in an increased vulnerability to infections, but until recently the biological mechanisms behind this observation were not well defined. Immunosuppression and concurrent sustained peripheral inflammation after spinal cord injury have been observed in preclinical and clinical studies, now termed spinal cord injury-induced immune depression syndrome. Recent research indicates a key instigator of this immune dysfunction is altered sympathetic input to lymphoid organs, such as the spleen, resulting in a wide array of secondary effects that can, in turn, exacerbate immune pathology. In this review, we discuss what we know about immune dysfunction after spinal cord injury, why it occurs, and how we might treat it. Abstract Individuals with spinal cord injuries (SCI) exhibit increased susceptibility to infection, with pneumonia consistently ranking as a leading cause of death. Despite this statistic, chronic inflammation and concurrent immune suppression have only recently begun to be explored mechanistically. Investigators have now identified numerous changes that occur in the peripheral immune system post-SCI, including splenic atrophy, reduced circulating lymphocytes, and impaired lymphocyte function. These effects stem from maladaptive changes in the spinal cord after injury, including plasticity within the spinal sympathetic reflex circuit that results in exaggerated sympathetic output in response to peripheral stimulation below injury level. Such pathological activity is particularly evident after a severe high-level injury above thoracic spinal cord segment 6, greatly increasing the risk of the development of sympathetic hyperreflexia and subsequent disrupted regulation of lymphoid organs. Encouragingly, studies have presented evidence for promising therapies, such as modulation of neuroimmune activity, to improve regulation of peripheral immune function. In this review, we summarize recent publications examining (1) how various immune functions and populations are affected, (2) mechanisms behind SCI-induced immune dysfunction, and (3) potential interventions to improve SCI individuals’ immunological function to strengthen resistance to potentially deadly infections.
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Attenuation of autonomic dysreflexia during functional electrical stimulation cycling by neuromuscular electrical stimulation training: case reports. Spinal Cord Ser Cases 2020; 6:12. [PMID: 32127515 DOI: 10.1038/s41394-020-0262-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) may cause impairments of the motor, sensory, and autonomic nervous systems, which result in adverse changes in body composition and cardiovascular health. Functional electrical stimulation (FES) cycling may provide an effective alternative approach to perform exercise and improve cardiovascular health after SCI. Persons with an injury at or above T6 level are at high risk of developing a life-threatening complication of autonomic dysreflexia (AD). CASE PRESENTATION Two participants with motor-complete C6 SCI completed either 12 weeks of passive range of motion or surface neuromuscular electrical stimulation (NMES) resistance training, followed by 12 weeks of functional electrical stimulation (FES) lower extremity cycling for both participants. Systolic and diastolic blood pressure (BP) were measured to determine the effects of NMES-resistance training and FES-lower extremity cycling during rest and exercise. DISCUSSION The difference between mean value of BP during FES-lower extremity cycling exercise and resting BP averaged for 24 sessions was smaller for participant A (31.25 mmHg for systolic BP and 10.44 mmHg for diastolic BP), who received NMES-resistance training, as compared with participant B (58.62 mmHg for systolic BP and 35.07 mmHg for diastolic BP). The results of these case reports suggest that 12 weeks of NMES-resistance training preceding FES-lower extremity cycling may attenuate the development of AD after SCI. Risk of AD, triggered by noxious stimuli, may be dampened with FES-lower extremity cycling training in persons with SCI.
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Shang Z, Jia C, Yan H, Cui B, Wu J, Wang Q, Gao W, Cui X, Li J, Ou T. Injecting RNA interference lentiviruses targeting the muscarinic 3 receptor gene into the bladder wall inhibits neurogenic detrusor overactivity in rats with spinal cord injury. Neurourol Urodyn 2018; 38:615-624. [DOI: 10.1002/nau.23894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Zhenhua Shang
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Chunsong Jia
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Hao Yan
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Bo Cui
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Jiangtao Wu
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Qi Wang
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Wei Gao
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Xin Cui
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Jin Li
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
| | - Tongwen Ou
- Department of UrologyXuanwu Hospital Capital Medical UniversityXuanwu DistrictBeijingChina
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Flack CK, Mellon MJ. Current Management Strategies for Autonomic Dysreflexia. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0488-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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9
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Phé V, Schneider MP, Peyronnet B, Abo Youssef N, Mordasini L, Chartier-Kastler E, Bachmann LM, Kessler TM. Intravesical vanilloids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review and meta-analysis. A report from the Neuro-Urology Promotion Committee of the International Continence Society (ICS). Neurourol Urodyn 2017; 37:67-82. [PMID: 28618110 DOI: 10.1002/nau.23314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022]
Abstract
AIMS To systematically assess all available evidence on efficacy and safety of vanilloids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS). METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus, (last search January 8, 2016). RESULTS After screening of 7848 abstracts, 4 randomized controlled trials (RCTs) and 3 prospective cohort studies were included. Pooled data from three RCTs evaluating intravesical capsaicin showed the standardized mean difference to be -2.16 (95% confidence interval [CI] -2.87 to -1.45) in incontinence episodes per 24 h and -0.54 (95%CI -1.03 to -0.05) in voids per 24 h. There was no statistically significant effect on maximum cystometric capacity and maximum storage detrusor pressure. Overall, adverse events were reported by >50% of the patients, most commonly were pelvic pain, facial flush, worsening of incontinence, autonomic dysreflexia, urinary tract infection and haematuria. Risk of bias and confounding was relevant in both RCTs and non-RCTs. CONCLUSIONS Preliminary data suggest that intravesical vanilloids might be effective for treating NLUTD in patients with MS. However, the safety profile seems unfavorable, the overall quality of evidence is low and no licensed substance is currently available warranting well-designed, adequately sampled and properly powered RCTs.
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Affiliation(s)
- Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Brain Research Institute, University of Zürich, and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland
| | | | - Nadim Abo Youssef
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Livio Mordasini
- Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France
| | | | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Kadekawa K, Yoshizawa T, Wada N, Shimizu T, Majima T, Tyagi P, de Groat WC, Sugaya K, Yoshimura N. Effects of liposome-based local suppression of nerve growth factor in the bladder on autonomic dysreflexia during urinary bladder distention in rats with spinal cord injury. Exp Neurol 2017; 291:44-50. [PMID: 28174025 DOI: 10.1016/j.expneurol.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine (1) whether spinal cord injury (SCI) time-dependently increases the severity of autonomic dysreflexia (AD) and expression levels of bladder nerve growth factor (NGF) protein, and (2) whether local suppression of NGF in the bladder improves SCI-induced AD in rats. MATERIALS AND METHODS SCI was produced by the transection of the T2/3 spinal cord in female Sprague-Dawley rats. At 4 or 8weeks after SCI, differences in the mean arterial blood pressure (ΔMAP) and heart rate (ΔMHR) during graded increases in intravesical pressure to 20, 40 and 60cm H2O from those before bladder distention and NGF protein levels in the bladder wall were evaluated in spinal intact and SCI rats under urethane anesthesia. Seven weeks after SCI liposome-NGF antisense conjugates were administered intravesically to the animals. At 1week after intravesical treatment (8weeks after SCI), ΔMAP and ΔMHR during bladder distention and bladder NGF protein expression were evaluated. RESULTS The ΔMAP and ΔMHR were increased in a graded manner in response to bladder distention at intravesical pressures of 20, 40 and 60cm H2O in SCI rats. These AD-like cardiovascular responses and NGF protein expression in the bladder mucosal and muscle layers were increased after SCI in a time-dependent manner. The liposome-NGF antisense treatment significantly reduced the NGF protein overexpression in the mucosal layer of SCI rat bladder and reduced ΔMAP and ΔMHR elicited by bladder distention. CONCLUSIONS These results indicate that the duration of the post-SCI recovery period affects the severity of AD induced by bladder distention as well as the level of bladder NGF protein, and that local suppression of NGF expression in the bladder reduces SCI-induced AD. Thus, Intravesical application of liposome-NGF antisense conjugates can be a new effective therapy for bladder distention-induced AD after SCI.
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Affiliation(s)
- Katsumi Kadekawa
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Southern Knights' Laboratory, Okinawa, Japan; Okinawa Kyodo Hospital, Okinawa, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takahiro Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tsuyoshi Majima
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology & Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Pharmacology & Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Abstract
Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic performance, which holds promise as a potential therapeutic approach.
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Affiliation(s)
- Hisham Sharif
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Shaoping Hou
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
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Stothers L, Locke JA, Macnab A, Nigro M. Long-Term Urologic Evaluation Following Spinal Cord Injury. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caruso D, Gater D, Harnish C. Prevention of recurrent autonomic dysreflexia: a survey of current practice. Clin Auton Res 2015; 25:293-300. [PMID: 26280219 DOI: 10.1007/s10286-015-0303-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a dearth of literature on the treatment of chronic recurrent autonomic dysreflexia (AD), a well-known complication of spinal cord injury that can have life-threatening implications. This study sought to identify clinical practices regarding the treatment of AD, both acute and recurrent, in patients with spinal cord injury (SCI). METHODS Online survey regarding AD management in SCI composed of 11 questions designed to obtain information on respondent characteristics, AD treatment options, and causes of AD. SETTING Veterans Administration health care system. PARTICIPANTS Veterans Health Administration National SCI Staff Physicians were sent an electronic email to participate in the anonymous web-based survey. INTERVENTION None applicable. RESULTS The response rate was 52%. The most commonly prescribed medications for minor and severe acute manifestations of AD were nitrates. For recurrent AD, clonidine was the most commonly prescribed medication. INTERPRETATION Anti-hypertensive medications continue to be the mainstay in the management of both acute and chronic recurrent AD. Current literature is lacking in prospective randomized controlled trials investigating the relative efficacy of AD interventions. Evidence-based practice guidelines are necessary to improve clinical care.
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Affiliation(s)
- Deborah Caruso
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, USA. .,Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA.
| | - David Gater
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, USA.,Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Christopher Harnish
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, USA.,Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
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Clinical guidelines for the diagnosis and management of neurogenic lower urinary tract dysfunction. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aizawa N, Ogawa S, Sugiyama R, Homma Y, Igawa Y. Influence of urethane-anesthesia on the effect of resiniferatoxin treatment on bladder function in rats with spinal cord injury. Neurourol Urodyn 2013; 34:274-9. [PMID: 24375785 DOI: 10.1002/nau.22549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/26/2013] [Indexed: 12/31/2022]
Abstract
AIMS We investigated the effect of resiniferatoxin (RTX)-treatment on cystometric parameters in the spinal cord injury (SCI) rats in both conscious and urethane-anesthetized conditions and evaluated the influence of urethane-anesthesia on the effect of RTX on lower urinary tract (LUT) function in SCI rats. METHODS Female Sprague-Dawley rats were used. SCI was created by transection of the T8-T9 spinal cord. Four weeks after the transection, the animals were placed in a restraint cage for the first cystometric measurements in a conscious state. Secondary cystometric measurements were performed in a conscious condition following the 1 day after RTX-(0.3 mg/kg) or vehicle-subcutaneous injection. Then the animals were injected with urethane (1.5 g/kg, subcutaneously), and cystometric measurements were repeated four times every 1 hr-interval. RESULTS After the RTX-treatment in a conscious condition, urinary retention was observed in three out of five animals. In addition, the number of non-voiding contractions (NVCs) significantly decreased although their amplitude did not change significantly. After the urethane-injection, all of the animals treated with RTX developed urinary retention. The amplitude of NVCs significantly decreased, whereas the number of NVCs did not change significantly in the RTX-treated group. No cystometric parameters significantly changed after either vehicle- or urethane-injection in the vehicle-treated group. CONCLUSIONS The present results indicate that the suppressive effects of RTX on NVCs as well as voiding contractions in SCI rats can be enhanced by urethane-anesthesia. Such suppressive effect of urethane-anesthesia itself should be taken into consideration when we evaluate a drug-effect on LUT function in rats with SCI.
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Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Autonomic Dysreflexia: Evaluation and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Watanabe N, Akino H, Kurokawa T, Taga M, Yokokawa R, Tanase K, Nagase K, Yokoyama O. Antidiuretic effect of antimuscarinic agents in rat model depends on C-fibre afferent nerves in the bladder. BJU Int 2013; 112:131-6. [PMID: 23432937 DOI: 10.1111/j.1464-410x.2012.11747.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Antichollnergic agents are anticipated to diminish storage symptoms, as well as nocturia. Nevertheless, the effect of this treatment on polyuria related to nocturia is not clear. By subgroup analysis of the data set from a phase III clinical trial of antimuscarinic agent for OAB patients in Japan, imidafenacin was found to improve nocturia with a reduction in nocturnal polyuria. This study adds the effects and underlying mechanism of antimuscarinic agents decreasing urine production through inhibition of C-fibre in the bladder of water-leaded rats. OBJECTIVE To evaluate the effects and underlying mechanisms of antimuscarinic agents used to decrease in urine production in water-loaded rats. SUBJECTS AND METHODS Urine production was measured using a cystostomy catheter in female Sprague-Dawley rats every 2 h. The effect of the antimuscarinic agents atropine, tolterodine and imidafenacin on urine production was investigated under water-loaded conditions, which were induced by i.p. injection of 15 mL saline. Blood samples were collected to determine the levels of antidiuretic hormone (ADH), aldosterone (ALD), atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) before, and 2 and 8 h after, antimuscarinic agent administration. To induce desensitization of C-fibre afferent nerves, resiniferatoxin (RTX)was injected s.c. or intravesically 2 days before experiments. RESULTS Urine production increased and reached its maximum 2 h after 15 mL saline injection. Imidafenacin and tolterodine decreased urine production in water-loaded rats, but ADH, ALD, ANP and BNP levels were not different between imidafenacin-treated and vehicle-treated rats. The inhibitory effect on urine production was not found in RTX-treated rats. Atropine did not reduce urine production. CONCLUSION These results suggest that antimuscarinic agents decrease urine volume through C-fibres in the bladder; thus, antimuscarinics with inhibitory effects on C-fibres could be beneficial for nocturia with nocturnal polyuria.
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Affiliation(s)
- Nozomu Watanabe
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
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Charrua A, Avelino A, Cruz F. Modulation of urinary bladder innervation: TRPV1 and botulinum toxin A. Handb Exp Pharmacol 2011:345-374. [PMID: 21290235 DOI: 10.1007/978-3-642-16499-6_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The persisting interest around neurotoxins such as vanilloids and botulinum toxin (BoNT) derives from their marked effect on detrusor overactivity refractory to conventional antimuscarinic treatments. In addition, both are administered by intravesical route. This offers three potential advantages. First, intravesical therapy is an easy way to provide high concentrations of pharmacological agents in the bladder tissue without causing unsuitable levels in other organs. Second, drugs effective on the bladder, but inappropriate for systemic administration, can be safely used as it is the case of vanilloids and BoNT. Third, the effects of one single treatment might be extremely longlasting, contributing to render these therapies highly attractive to patients despite the fact that the reasons to the prolonged effect are still incompletely understood. Attractive as it may be, intravesical pharmacological therapy should still be considered as a second-line treatment in patients refractory to conventional oral antimuscarinic therapy or who do not tolerate its systemic side effects. However, the increasing off-label use of these neurotoxins justifies a reappraisal of their pharmacological properties.
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Affiliation(s)
- Ana Charrua
- Institute of Histology and Embryology, Porto, Portugal
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CHENG CL. Spinal Cord Injury-Induced Neurogenic Bladder. Low Urin Tract Symptoms 2009. [DOI: 10.1111/j.1757-5672.2009.00018.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Krassioukov A, Warburton DER, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009; 90:682-95. [PMID: 19345787 PMCID: PMC3108991 DOI: 10.1016/j.apmr.2008.10.017] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/25/2008] [Accepted: 10/06/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD). DATA SOURCES A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD. STUDY SELECTION Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded. DATA EXTRACTION Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers. DATA SYNTHESIS Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E(2)). CONCLUSIONS A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.
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Affiliation(s)
- Andrei Krassioukov
- International Collaboration on Repair Discoveries (ICORD)
- Division of Physical Medicine and Rehabilitation, University of BC, Vancouver, Canada
- Department of Physical Therapy, University of BC, Vancouver, Canada
| | - Darren ER Warburton
- International Collaboration on Repair Discoveries (ICORD)
- Cardiovascular Physiology and Rehabilitation Laboratory & Experimental Medicine, University of BC, Vancouver, Canada
| | - Robert Teasell
- Department of Physical Medicine & Rehabilitation, University of Western Ontario, London, ON, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries (ICORD)
- Department of Physical Therapy, University of BC, Vancouver, Canada
- Rehabilitation Research Laboratory, GF Strong Rehab Centre, Vancouver, Canada
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Thomas C, Kim JH, Torimoto K, Kwon DD, Kim YT, Tyagi P, Yoshimura N, Chancellor MB. Early capsaicin intervention for neurogenic bladder in a rat model of spinal cord injury. ACTA ACUST UNITED AC 2008; 28:255-9. [PMID: 18000338 DOI: 10.2220/biomedres.28.255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We explored capsaicin pretreatment, prior to spinal trauma, as a method to prevent the development of neurogenic detrusor overactivity (NDO) and urethral-bladder dyssynergia reflex after spinal cord injury (SCI). In addition, the duration of effect of capsaicin therapy on NDO in a rat model of SCI was investigated. Two sets of experiments were performed on female Sprague Dawley rats transected at the T9-T10 spinal level. First, SCI rats received capsaicin (125 mg/kg s.q.) 3-4 days before and 4-5 days after SCI. Cystometrograms (CMG) was performed 4 weeks after injury. In the second set of experiments, serial CMG in the same SCI animal was performed after one time injection of capsaicin (125 mg/kg s.q.) 4 weeks after spinalization. There were no differences in intercontraction intervals, voiding efficiency, or voiding pressure between the capsaicin pretreated and control SCI rats. However, the number of uninhibited detrusor contractions decreased 4 weeks after injury. We found that a single dose of capsaicin suppressed uninhibited detrusor contractions for 34 days in the chronic SCI animals. Early therapy with capsaicin was able to prevent/reduce detrusor hyperreflexia in spinal cord injured animals 4 weeks after injury. Early vanilloid therapy may prevent development of urologic sequelae after SCI.
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Affiliation(s)
- Catherine Thomas
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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de Sèze M, Gallien P, Denys P, Labat JJ, Serment G, Grise P, Salle JY, Blazejewski S, Hazane C, Moore N, Joseph PA. Intravesical glucidic capsaicin versus glucidic solvent in neurogenic detrusor overactivity: a double blind controlled randomized study. Neurourol Urodyn 2007; 25:752-7. [PMID: 16986136 DOI: 10.1002/nau.20296] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS Many studies report the use of alcoholic capsaicin instillation to treat neurogenic detrusor overactivity (NDO) in spinal cord injured (SCI) and multiple sclerosis (MS) patients. However, poor tolerability due to the irritative effect of the ethanol solvent limits its use. Our study aimed to evaluate the efficacy and tolerability of a new formulation of capsaicin in a glucidic solution in a multicenter clinical trial. MATERIALS AND METHODS Thirty-three patients (26MS/7SCI) suffering from urinary incontinence due to refractory NDO were prospectively enrolled in a double-blind placebo controlled study and randomized to capsaicin group (CG, N = 17) or solvent group (SG, N = 16). They respectively received an intravesical instillation of 100 ml capsaicin diluted in glucidic solvent (CG) or glucidic solvent alone (SG). Efficacy (voiding chart, maximum cystometric capacity (MCC)) and tolerability were evaluated on days 0 (D0), 30 and 90. RESULTS On D0, groups were homogeneous. On D30, significant improvement of overactive bladder syndrome and an increase in MCC were shown in CG, whereas there were no improvement in SG. No significant improvement was shown on D90 in both groups. There were no significant differences between groups regarding prevalence, duration, or intensity of side effects, except for short duration pubic pain during instillation more often reported in CG (58.8%) than in SG (12.5%) (P < 0.01). CONCLUSION This placebo controlled study using glucidic capsaicin confirms its short-term efficacy in NDO patients. Global tolerance of glucidic capsaicin appeared satisfactory. Long-term efficacy and tolerance of repeated glucidic capsaicin instillations need to be evaluated.
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Affiliation(s)
- Marianne de Sèze
- Physical Medicine and Neurorehabilitation Unit, Bordeaux University Hospital, Bordeaux, France.
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Tyagi P, Wu PC, Chancellor M, Yoshimura N, Huang L. Recent advances in intravesical drug/gene delivery. Mol Pharm 2006; 3:369-79. [PMID: 16889430 PMCID: PMC2504416 DOI: 10.1021/mp060001j] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Targeting of drugs administered systemically relies on the higher affinity of ligands for specific receptors to obtain selectivity in drug response. However, achieving the same goal inside the bladder is much easier with an intelligent pharmaceutical approach that restricts drug effects by exploiting the pelvic anatomical architecture of the human body. This regional therapy involves placement of drugs directly into the bladder through a urethral catheter. It is obvious that drug administration by this route holds advantage in chemotherapy of superficial bladder cancer, and it has now become the most widely used treatment modality for this ailment. In recent years, the intravesical route has also been exploited either as an adjunct to an oral regimen or as a second-line treatment for neurogenic bladder. (Lamm, D. L.; Griffith, J. G. Semin. Urol. 1992, 10, 39-44. Igawa, Y.; Satoh, T.; Mizusawa, H.; Seki, S.; Kato, H.; Ishizuka, O.; Nishizawa, O. BJU Int. 2003, 91, 637-641.) Instillation of DNA via this route using different vectors has been able to restrict the transgene expression in organs other than bladder. The present review article will discuss the shortcomings of the current options available for intravesical drug delivery (IDD) and lay a perspective for future developments in this field.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh, at Chapel Hill
| | - Pao-Chu Wu
- School of Pharmacy, University of North Carolina at Chapel Hill
| | | | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, at Chapel Hill
| | - Leaf Huang
- School of Pharmacy, University of North Carolina at Chapel Hill
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de Groat WC, Yoshimura N. Mechanisms underlying the recovery of lower urinary tract function following spinal cord injury. PROGRESS IN BRAIN RESEARCH 2006; 152:59-84. [PMID: 16198694 DOI: 10.1016/s0079-6123(05)52005-3] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The lower urinary tract has two main functions, the storage and periodic expulsion of urine, which are regulated by a complex neural control system in the brain and lumbosacral spinal cord. This neural system coordinates the activity of two functional units in the lower urinary tract: (1) a reservoir (the urinary bladder) and (2) an outlet (consisting of bladder neck, urethra and striated muscles of the pelvic floor). During urine storage the outlet is closed and the bladder is quiescent, thereby maintaining a low intravesical pressure over a wide range of bladder volumes. During micturition the outlet relaxes and the bladder contracts to promote the release of urine. This reciprocal relationship between bladder and outlet is generated by visceral reflex circuits, some of which are under voluntary control. Experimental studies in animals indicate that the micturition reflex is mediated by a spinobulbospinal pathway passing through a coordination center (the pontine micturition center) located in the rostral brainstem. This reflex pathway is in turn modulated by higher centers in the cerebral cortex that are presumably involved in the voluntary control of micturition. Spinal cord injury at cervical or thoracic levels disrupts voluntary control of voiding as well as the normal reflex pathways that coordinate bladder and sphincter functions. Following spinal cord injury, the bladder is initially areflexic but then becomes hyperreflexic due to the emergence of a spinal micturition reflex pathway. Studies in animals indicate that the recovery of bladder function after spinal cord injury is dependent in part on plasticity of bladder afferent pathways and the unmasking of reflexes triggered by capsaicin-sensitive C-fiber bladder afferent neurons. The plasticity is associated with changes in the properties of ion channels and electrical excitability of afferent neurons, and appears to be mediated in part by neurotrophic factors released in the spinal cord and the peripheral target organs.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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D’Agostino G, Condino A, Gallinari P, Boselli C, Agazzi A, Tonini M. An appraisal of recently patented compounds for bladder overactivity and urinary incontinence. Expert Opin Ther Pat 2005. [DOI: 10.1517/13543776.14.7.1041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Although currently available antimuscarinic agents are the standard of care for overactive bladder (OAB), they are limited by certain side effects, particularly dry mouth and constipation. Research aimed at discovering new therapies for OAB has resulted in the identification of some promising drugs. Investigations of pharmacologic targets in the central nervous system (CNS) have yielded encouraging results with several agents, including tramadol and gabapentin. Further investigation may show that drugs acting at serotonergic and noradrenergic CNS sites are clinically useful as therapies for OAB. Some peripherally acting drugs, such as resiniferatoxin and botulinum toxin, have already been proved to be of clinical value. However, development of other agents that block afferent or efferent nerve impulses in the bladder through activity at vanilloid, purinergic, or opioid-like receptor sites may result in clinically useful drugs.
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Affiliation(s)
- Karl-Erik Andersson
- Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden.
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