Non-bacterial cystitis

IGFBP1 stabilizes Umod expression through m6A modification to inhibit the occurrence and development of cystitis by blocking NF-κB and ERK signaling pathways

Cystitis is a common disease closely associated with urinary tract infections, and the specific mechanisms underlying its occurrence and development remain largely unknown. In this study, we discovered that IGFBP1 suppresses the occurrence and development of cystitis by stabilizing the expression of Umod through m6A modification, inhibiting the NF-κB and ERK signaling pathways. Initially, we obtained a bladder cystitis-related transcriptome dataset from the GEO database and identified the characteristic genes Umod and IGFBP1. Further exploration revealed that IGFBP1 in primary cells of cystitis can stabilize the expression of Umod through m6A modification. Overexpression of both IGFBP1 and Umod significantly inhibited cell apoptosis and the NF-κB and ERK signaling pathways, ultimately suppressing the production of pro-inflammatory factors. Finally, using a rat model of cystitis, we demonstrated that overexpression of IGFBP1 stabilizes the expression of Umod, inhibits the NF-κB and ERK signaling pathways, reduces the production of pro-inflammatory factors, and thus prevents the occurrence and development of cystitis. Our study elucidates the crucial role of IGFBP1 and Umod in cystitis and reveals the molecular mechanisms that inhibit the occurrence and development of cystitis. This research holds promise for offering new insights into the treatment of cystitis in the future.

Hydrodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: safety, diagnostic potential and therapeutic efficacy

OBJECTIVES

To evaluate the safety, diagnostic potential and therapeutic efficacy of cystoscopy with hydrodistension under local anesthesia in patients with suspected painful bladder syndrome/interstitial cystitis (PBS/IC).

METHODS

Thirty-six patients with frequency, urgency or bladder pain for > or = 6 months and an average voided volume of <200 mL were enrolled in the study. Hydrodistension was carried out 10 min after instillation of 10 mL of 4% lidocaine. The instilled saline volume for hydrodistension was determined based on each patient's level of tolerance of urinary sensation and symptoms.

RESULTS

Overall, 30 patients (median age 54 years, range 25-76) were evaluated. The median instilled saline volume was 450 mL (250 to 580 mL). No patients were admitted to hospital due to adverse events associated with hydrodistension. Glomerulation was found in 23 patients and two had Hunner's ulcers. Therapeutic efficacy at one month after hydrodistension was shown in 21/30 patients (71%). A median efficacy period of 20 + or = 3.7 weeks was determined by Kaplan-Meier analysis. Factors with an independent influence on therapeutic efficacy of hydrodistension were not identified, but patients with an instilled volume greater than the median volume had significantly longer efficacy periods (P < 0.022).

CONCLUSIONS

Cystoscopy with hydrodistension under local anesthesia provides a simple and safe method for differential diagnosis and has some therapeutic efficacy in patients with suspected PBS/IC.

Sex differences in the expression profile of acid-sensing ion channels in the mouse urinary bladder: a possible involvement in irritative bladder symptoms

OBJECTIVE

To investigate the expressions and sex differences of acid-sensitive ion channels (i.e. ASIC and transient receptor potential channel V1, TRPV1; both key receptors for extracellular protons that might underlie the acid-evoked pain perception) and other nociceptive ion channels in the mouse bladder.

MATERIALS AND METHODS

Mucosa and muscle layers of the urinary bladder were separately taken from male and female mice. The gene expressions of ASIC subunits, TRPV1, TRPA1 and TRPM8 were quantified using real-time reverse transcriptase-polymerase chain reaction. The localization of ASIC protein was explored using immunohistochemistry. Continuous-filling cystometry was used to examine the effects of capsazepine, a TRPV1 blocker, on the bladder response to acetic acid.

RESULTS

ASIC1 was the dominant ASIC subunit expressed in bladder epithelium, whereas both ASIC1 and ASIC2 were expressed in bladder smooth muscle. ASIC3 expression was much less abundant, but localized in the subepithelial region. In the mucosa, the ASIC1 gene was more highly expressed in male than in female mice, whereas the expression level of ASIC2 in the bladder muscle was higher in female than in male mice. The expression of TRPV1 in the bladder showed a sex difference (male < female), but it was much lower than ASIC genes. Furthermore, the intravesical administration of 100 microm capsazepine showed no effect on bladder irritation by acetic acid. TRPA1 and TRPM8 did not show sex differences in their expression.

CONCLUSION

The expression of ASIC subunit in the bladder was abundant and showed significant sex differences. Thus, ASICs might be involved in the sex difference in the bladder response to acidic irritation.

A double-blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome

AIM

To evaluate the effect of 0.3 M potassium chloride on cystometric parameters by comparing it with normal saline as a filling solution in women with overactive bladder (OAB).

PATIENTS AND METHODS

Twenty-three women with significant OAB symptoms underwent consecutive cystometrograms (CMGs) using 0.9% normal saline (NS) and 0.3 M potassium chloride (KCl), the order of which was randomized for each patient. Individual CMGs were performed by separate investigators and both patients and investigators were blinded to the order in which each solution was given and to the results of the other CMG.

RESULTS

Regardless of the nature of the filling solution, the order in which the CMGs were performed had little influence on either first desire to void (FDV, mean 83.5 ml vs. 117.8 ml for first and second CMGs respectively, P = 0.10) or on maximum cystometric capacity (Cmax, mean 265.0 ml vs. 264.4 ml, P = 0.98). KCl produced a significant (24%) reduction in mean Cmax compared to NS (mean 228.6 ml vs. 300.8 ml, P = 0.001), irrespective of the order of infusion.

CONCLUSION

This comparative study using 0.3 M KCl versus NS as filling solutions suggests that intravesical potassium may not simply act on urothelial sensory nerve endings; it may also stimulate detrusor muscle contraction. These findings may influence the interpretation of the potassium sensitivity test in patients with OAB symptoms, particularly in those suspected of having interstitial cystitis.

Comparative assessment of maximal bladder capacity, 0.9% NaCl versus 0.2 M Kcl, for the diagnosis of interstitial cystitis: a prospective controlled study

PURPOSE

Increased urothelial permeability has been proposed as a cause of interstitial cystitis (IC). The potassium sensitivity test assesses bladder discomfort after instillation of 0.4 M KCl for identification of increased urothelial permeability. Since exposure to 0.4 M KCl may be extremely painful for patients with IC we investigated a less traumatic alternative.

MATERIALS AND METHODS

The study comprised 38 controls and 40 patients with IC. In all subjects cystometry was performed with 0.9% NaCl followed by 0.2 M KCl, and filling volume at first urge and maximum bladder capacity (Cmax) were assessed for both solutions.

RESULTS

Controls did not show a significant change in Cmax. KCl decreased Cmax in 37 of 40 (92%) patients with IC with a mean decrease of 30%. The examination was painless in all controls and in 33 of 40 (82%) patients with IC, and was moderately painful in 7.

CONCLUSIONS

For demonstration of increased potassium sensitivity and diagnosis of IC, comparative assessment of Cmax is a well tolerated alternative to the 0.4 M potassium sensitivity test. Statistical evaluation of these results suggests that a decrease in Cmax greater than 30% is indicative of IC.