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Mohammad A, Laboulaye MA, Shenhar C, Dobberfuhl AD. Mechanisms of oxidative stress in interstitial cystitis/bladder pain syndrome. Nat Rev Urol 2024; 21:433-449. [PMID: 38326514 DOI: 10.1038/s41585-023-00850-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder and/or pelvic pain, increased urinary urgency and frequency and nocturia. The pathophysiology of IC/BPS is poorly understood, and theories include chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of the glycosaminoglycan (GAG) barrier and urine cytotoxicity. Multiple treatment options exist, including behavioural interventions, oral medications, intravesical instillations and procedures such as hydrodistension; however, many clinical trials fail, and patients experience an unsatisfactory treatment response, likely owing to IC/BPS phenotype heterogeneity and the use of non-targeted interventions. Oxidative stress is implicated in the pathogenesis of IC/BPS as reactive oxygen species impair bladder function via their involvement in multiple molecular mechanisms. Kinase signalling pathways, nociceptive receptors, mast-cell activation, urothelial dysregulation and circadian rhythm disturbance have all been linked to reactive oxygen species and IC/BPS. However, further research is necessary to fully uncover the role of oxidative stress in the pathways driving IC/BPS pathogenesis. The development of new models in which these pathways can be manipulated will aid this research and enable further investigation of promising therapeutic targets.
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Affiliation(s)
- Ashu Mohammad
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mallory A Laboulaye
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chen Shenhar
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA.
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Yang Y, Qu JY, Guo H, Zhou HY, Ruan X, Peng YC, Shen XF, Xiong J, Wang YL. Electroacupuncture at Sensitized Acupoints Relieves Somatic Referred Pain in Colitis Rats by Inhibiting Sympathetic-Sensory Coupling to Interfere with 5-HT Signaling Pathway. Chin J Integr Med 2024; 30:152-162. [PMID: 38038835 DOI: 10.1007/s11655-023-3565-8] [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] [Accepted: 08/16/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To investigate whether electroacupuncture (EA) at sensitized acupoints could reduce sympathetic-sensory coupling (SSC) and neurogenic inflammatory response by interfering with 5-hydroxytryptamine (5-HT)ergic neural pathways to relieve colitis and somatic referred pain, and explore the underlying mechanisms. METHODS Rats were treated with 5% dextran sodium sulfate (DSS) solution for 7 days to establish a colitis model. Twelve rats were randomly divided into the control and model groups according to a random number table (n=6). According to the "Research on Rat Acupoint Atlas", sensitized acupoints and non-sensitized acupoints were determined. Rats were randomly divided into the control, model, Zusanli-EA (ST 36), Dachangshu-EA (BL 25), and Xinshu (BL 15) groups (n=6), as well as the control, model, EA, and EA + GR113808 (a 5-HT inhibitor) groups (n=6). The rats in the control group received no treatment. Acupuncture was administered on 2 days after modeling using the stimulation pavameters: 1 mA, 2 Hz, for 30 min, with sparse and dense waves, for 14 consecutive days. GR113808 was injected into the tail vein at 5 mg/kg before EA for 10 min for 7 consecutive days. Mechanical sensitivity was assessed with von Frey filaments. Body weight and disease activity index (DAI) scores of rats were determined. Hematoxylin and eosin staining was performed to observe colon histopathology. SSC was analyzed by immunofluorescence staining. Immunohistochemical staining was performed to detect 5-HT and substance P (SP) expressions. The calcitonin gene-related peptide (CGRP) in skin tissue and tyrosine hydroxylase (TH) protein levels in DRG were detected by Western blot. The levels of hyaluronic acid (HA), bradykinin (BK), prostaglandin I2 (PGI2) in skin tissue, 5-HT, tryptophan hydroxylase 1 (TPH1), serotonin transporters (SERT), 5-HT 3 receptor (5-HT3R), and 5-HT 4 receptor (5-HT4R) in colon tissue were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS BL 25 and ST 36 acupoints were determined as sensitized acupoints, and BL 15 acupoint was used as a non-sensitized acupoint. EA at sensitized acupoints improved the DAI score, increased mechanical withdrawal thresholds, and alleviated colonic pathological damage of rats. EA at sensitized acupoints reduced SSC structures and decreased TH and CGRP expression levels (P<0.05). Furthermore, EA at sensitized acupoints reduced BK, PGI2, 5-HT, 5-HT3R and TPH1 levels, and increased HA, 5-HT4R and SERT levels in colitis rats (P<0.05). GR113808 treatment diminished the protective effect of EA at sensitized acupoints in colitis rats (P<0.05). CONCLUSION EA at sensitized acupoints alleviated DSS-induced somatic referred pain in colitis rats by interfering with 5-HTergic neural pathway, and reducing SSC inflammatory response.
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Affiliation(s)
- Ying Yang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jin-Yu Qu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Hua Guo
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Hai-Ying Zhou
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Xia Ruan
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Ying-Chun Peng
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Xue-Fang Shen
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Jin Xiong
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Yi-Li Wang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China.
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
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Spinal Cord Injury Causes Marked Tissue Rearrangement in the Urethra-Experimental Study in the Rat. Int J Mol Sci 2022; 23:ijms232415951. [PMID: 36555592 PMCID: PMC9783636 DOI: 10.3390/ijms232415951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) results in the time-dependent development of urinary impairment due to neurogenic detrusor overactivity (NDO) and detrusor-sphincter-dyssynergia (DSD). This is known to be accompanied by massive changes in the bladder wall. It is presently less clear if the urethra wall also undergoes remodelling. To investigate this issue, female rats were submitted to complete spinal transection at the T8/T9 level and left to recover for 1 week and 4 weeks. To confirm the presence of SCI-induced NDO, bladder function was assessed by cystometry under urethane anesthesia before euthanasia. Spinal intact animals were used as controls. Urethras were collected and processed for further analysis. Following thoracic SCI, time-dependent changes in the urethra wall were observed. Histological assessment revealed marked urethral epithelium reorganization in response to SCI, as evidenced by an increase in epithelial thickness. At the muscular layer, SCI resulted in strong atrophy of the smooth muscle present in the urethral sphincter. Innervation was also affected, as evidenced by a pronounced decrease in the expression of markers of general innervation, particularly those present in sensory and sympathetic nerve fibres. The present data show an evident impact of SCI on the urethra, with significant histological rearrangement, accompanied by sensory and sympathetic denervation. It is likely that these changes will affect urethral function and contribute to SCI-induced urinary dysfunction, and they deserve further investigation.
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Lu Y, Li J, Dong L, Luo P, Zhang G, Rong W. Activation of uroepithelial 5-HT4R inhibits mechanosensory activity of murine bladder afferent nerves. Front Physiol 2022; 13:990178. [PMID: 36176773 PMCID: PMC9514655 DOI: 10.3389/fphys.2022.990178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Serotonin (5-HT) is known to act via multiple 5-HT receptors at spinal and supraspinal levels to regulate micturition. However, the contribution of peripheral 5-HT and its receptors in bladder physiology and pathology is not very well understood, despite evidence showing expression of multiple 5-HT receptors in the bladder wall and 5-HT may activate bladder afferent nerves. The current study was designed to investigate the possible role of 5-HT4R in modulation of the sensitivity of bladder afferents to bladder filling. Immunofluorescent staining showed abundant 5-HT4R immunoreactivity largely confined to the uroepithelium in wild type (WT) but not 5-HT4R−/− mice. In the ex vivo bladder-pelvic nerve preparation, intravesical application of the 5-HT4R agonist RS67333 (1–30 μm) caused concentration-dependent decreases of the pelvic nerve response to bladder filling. Such effect was not observed in the presence of 5-HT4R antagonist GR125487 or in 5-HT4R−/− preparations. A cohort of 5-HT4R−/− and WT control mice were treated with intraperitoneal injections of cyclophosphamide (CYP) (75 mg/kg, three times at 2 days interval) to induce chronic cystitis. Void spot analysis showed that CYP-treated 5-HT4R−/− mice urinated more frequently than their CYP-treated WT counterparts. Concomitantly, bladder afferents of CYP-treated 5-HT4R−/− mice displayed exaggerated sensitivity to bladder filling in comparison with the CYP-treated WT controls. These data suggest that 5-HT4R expressed on uroepithelial cells plays an inhibitory role in mechanosensory transduction in the bladder. Loss of 5-HT4R-mediated inhibition may enhance bladder afferent sensitivity and exacerbate bladder overactivity in pathological conditions. We propose that 5-HT4R agonists might be exploited for the treatment of overactive and painful bladder symptoms.
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Geramipour A, Danziger ZC. Age is associated with reduced urethral pressure and afferent activity in rat. Physiol Rep 2021; 9:e15107. [PMID: 34755496 PMCID: PMC8578905 DOI: 10.14814/phy2.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
Age-related changes in the lower urinary tract (LUT) can affect the coordination of reflexes and increase the incidence of bladder disorders in elderly. This study examines the age-related loss of urethral signaling capability by measuring the afferent activity directly. We find that less urethral pressure develops in response to fluid flow in old rats compared to young rats and that pressure and flow evoke less urethral afferent activation. These findings are consistent with our previous study demonstrating that the urethra-to-bladder reflex, which is required for efficient voiding, becomes weaker with age. We measured the pudendal afferent response in young (4-7 months) and old (18-24 months) rats to fluid flow in the urethra across a range of flow rates. We used paraffin embedding and hematoxylin and eosin staining to quantify age-related changes in the sensory branch of the pudendal nerve. Urethral afferent signaling in response to the same urethral flow rates was weaker in older animals. That is, the sensitivity of urethra afferents to flow decreased with age, and higher flow rates were required in older animals to recruit urethra afferents. There was also a reduction in the myelin thickness of pudendal afferents in old rats, which is a possible contributing factor to the sensory activity. Furthermore, the same flow rates evoked less pressure in the urethras of old animals, indicating there is an age-related change of the urethral tissue that reduces the pressure stimulus to which these afferents respond. These results help characterize the underlying changes in LUT system with age.
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Affiliation(s)
- Arezoo Geramipour
- Department of Biomedical EngineeringFlorida International UniversityMiamiFloridaUSA
| | - Zachary C. Danziger
- Department of Biomedical EngineeringFlorida International UniversityMiamiFloridaUSA
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West EG, Sellers DJ, Chess-Williams R, McDermott C. The anxiolytic sertraline reduces the impact of psychological stress on bladder function in mice. Life Sci 2021; 278:119598. [PMID: 33984361 DOI: 10.1016/j.lfs.2021.119598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023]
Abstract
AIMS To determine if treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline reduces the bladder dysfunction caused by water avoidance stress in mice. MAIN METHODS Adult female mice were randomly allocated to (1) Unstressed, (2) Stressed or (3) Stress + Sertraline experimental groups. Stressed mice were subjected to water avoidance for 1 h/day for 10 days and received sertraline or vehicle in drinking water, starting 10-days prior to the first stress exposure. Age matched control/unstressed mice were house under normal conditions without stress exposure. Voiding behaviour was assessed throughout the experimental protocol. After the final stress exposure, a blood sample was taken to measure plasma corticosterone levels and bladders were removed, catheterised and intravesical pressure responses recorded during distension and in response to pharmacological agents. KEY FINDINGS Plasma corticosterone levels in sertraline-treated animals were equivalent to unstressed controls and significantly decreased compared to the stressed group. Voiding frequency was significantly increased in the stressed group, and treatment with sertraline significantly decreased voiding frequency, however, this remained elevated compared to unstressed control animals. Bladders from stressed mice displayed enhanced maximal contractile response to the muscarinic agonist carbachol and greater release of ACh in the serosal fluid, which was reduced to control levels by sertraline treatment. Spontaneous phasic contractions were not altered by stress but were significantly reduced in bladders from sertraline treated animals, relative to controls. SIGNIFICANCE These results indicate that management of voiding dysfunction caused by psychological stress may be aided by the addition of an SSRI such as sertraline.
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Affiliation(s)
- Eliza G West
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Donna J Sellers
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Catherine McDermott
- Centre for Urology Research, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia.
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Neurophysiological control of urinary bladder storage and voiding-functional changes through development and pathology. Pediatr Nephrol 2021; 36:1041-1052. [PMID: 32415328 DOI: 10.1007/s00467-020-04594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The effective storage of urine and its expulsion relies upon the coordinated activity of parasympathetic, sympathetic, and somatic innervations to the lower urinary tract (LUT). At birth, all mammalian neonates lack the ability to voluntary regulate bladder storage or voiding. The ability to control urinary bladder activity is established as connections to the central nervous system (CNS) form through development. The neural regulation of the LUT has been predominantly investigated in adult animal models where comparatively less is known about the neonatal and postnatal neurophysiological development that facilitate urinary continence. Furthermore, congenital neurological or anatomical defects can adversely affect both storage and voiding functions through postnatal development and into adulthood, leading to secondary conditions including vesicoureteral reflux, chronic urinary tract infections, and end-stage renal disease. Therefore, the aim of the review is to provide the current knowledge available on neurophysiological regulation of the LUT through pre- to postnatal development of human and animal models and the consequences of congenital anomalies that can affect LUT neural function.
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8
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Ferreira A, Duarte Cruz C. The urethra in continence and sensation: Neural aspects of urethral function. Neurourol Urodyn 2021; 40:744-752. [PMID: 33604909 DOI: 10.1002/nau.24632] [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: 10/22/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 11/08/2022]
Abstract
AIMS Traditionally, the urethra has been considered a mere conduit to guide urine from the bladder to the external side of the body. Building evidence indicates that the urethra may directly influence bladder function via mechanisms restricted to the lower urinary tract (LUT). METHODS Here, we discuss the tissue arrangement of the urethra and addressed the contribution of new paraneuronal cells to LUT function. We also briefly reviewed two frequent LUT pathologies associated with urethral dysfunction. RESULTS Continence depends on an intact and functional urethral sphincter, composed of smooth, and striated muscle fibers and regulated by somatic and autonomic fibers. Recent studies suggest the existence of an urethro-vesical reflex that also contributes to normal LUT function. Indeed, the urethral lumen is lined by a specialized epithelium, the urothelium, in the proximal urethra. In this region, recent evidence demonstrates the presence of specific paraneuronal cells, expressing the neurotransmitters acetylcholine and serotonin. These cells are in close proximity of nerve fibers coursing in the lamina propria and are able to release neurotransmitters and rapidly induce detrusor contractions, supporting the existence of an urethro-vesical crosstalk. CONCLUSION The mechanism underlying the fast communication between the urethra and thebladder are beginning to be understood and should involve the interaction between specificepithelial cells and fibres innervating the urethral wall. It is likely that this reflex should bealtered in pathological conditions, becoming an attractive therapeutic target.
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Affiliation(s)
- Ana Ferreira
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.,Translational Neuro-Urology, Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
| | - Célia Duarte Cruz
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.,Translational Neuro-Urology, Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
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McCloskey KD, Wyndaele JJ, Speich JE, Birder L, Nelson PP. Should we be revisiting LUT basic science and clinical measurement of LUT sensation to improve patient care? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S23-S29. [PMID: 32662560 DOI: 10.1002/nau.24273] [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: 09/28/2019] [Accepted: 12/27/2019] [Indexed: 11/10/2022]
Abstract
AIMS This article reviews current knowledge of the underpinning mechanisms of how the bladder senses fullness locally and also revisits clinical measurements of lower urinary tract sensation. The former represents cellular sensing during bladder filling whereas the latter describes the sensations leading to conscious perception of bladder fullness. METHODS The topic was discussed in a "think tank" session at the 2019 International Consultation on Incontinence-Research Symposium in Bristol, UK; summarized in the present review. RESULTS Recent advances in the basic science of bladder sensing relating to (a) the bladder wall-urothelial cells, sensory nerves, interstitial cells, and smooth muscle cells and (b) putative chemo/mechanosensors in the urethra-paraneurons or "brush cells" are discussed. Validated clinical measurement of lower urinary tract sensation is reviewed in the context of how this could be better harnessed for patient benefit. We discuss the potential of app/tablet/mobile technology based on triggers and distractors to override aberrant local sensing/higher sensation and how these technologies could be utilized in treatment. CONCLUSIONS We conclude that a better understanding of bladder sensation is essential to inform clinical management of lower urinary tract symptoms.
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Affiliation(s)
- Karen D McCloskey
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - John E Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Birder
- Departments of Medicine-Renal Electrolyte Division and Pharmacology/Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pierre P Nelson
- Department of Physical Medicine and Rehabilitation, Hôpital Rothschild, Sorbonne Université, Paris, France
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Geramipour A, Danziger ZC. Sensitivity of urethral flow-evoked voiding reflexes decline with age in the rat: insights into age-related underactive bladder. Am J Physiol Renal Physiol 2020; 318:F1430-F1440. [DOI: 10.1152/ajprenal.00475.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The prevalence of underactive bladder (UAB) increases with age, suggesting a link between age-related processes and lower urinary tract (LUT) symptoms; however, the underlying mechanisms of age-related UAB are poorly understood. Understanding how aging affects LUT reflexes may help in the development of new treatments by identifying mechanistic targets. In this work, we studied the relationship between age and systems-level function of the LUT and tested the hypothesis that aging is related to weakening of reflexes that control voiding. Three groups of anesthetized female rats, young (4–7 mo old), mature (11–14 mo old), and old (18–24 mo old), were used to quantify the effect of aging on LUT reflexes. A double-lumen catheter enabled us to control the bladder volume and urethral flow rate independently, under quasi-isovolumetric bladder conditions. We systematically investigated the reflex bladder contractions evoked by combinations of rates of urethral infusion and bladder fill volumes as a function of age. Urethral infusion with the same flow rate evoked bladder contractions (via the augmenting reflex) in old animals less often than in younger animals. Furthermore, old animals needed more fluid in their bladders (relative to their bladder capacity) before urethra flow-evoked bladder contractions could be triggered at all, suggesting a delay in the switch of the LUT to “voiding mode.” Old rats also showed longer and weaker bladder contractions than young or mature rats. Taken together, this suggests there is an age-related functional weakening and loss of sensitivity in LUT reflexes, which may contribute to age-related UAB symptoms.
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Affiliation(s)
- Arezoo Geramipour
- Department of Biomedical Engineering, Florida International University, Miami, Florida
| | - Zachary C. Danziger
- Department of Biomedical Engineering, Florida International University, Miami, Florida
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Niendorf T, Frydman L, Neeman M, Seeliger E. Google maps for tissues: Multiscale imaging of biological systems and disease. Acta Physiol (Oxf) 2020; 228:e13392. [PMID: 31549487 DOI: 10.1111/apha.13392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | | | | | - Erdmann Seeliger
- Institute of Physiology Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Berlin Germany
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12
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van Thiel IAM, Botschuijver S, de Jonge WJ, Seppen J. Painful interactions: Microbial compounds and visceral pain. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165534. [PMID: 31634534 DOI: 10.1016/j.bbadis.2019.165534] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
Abstract
Visceral pain, characterized by abdominal discomfort, originates from organs in the abdominal cavity and is a characteristic symptom in patients suffering from irritable bowel syndrome, vulvodynia or interstitial cystitis. Most organs in which visceral pain originates are in contact with the external milieu and continuously exposed to microbes. In order to maintain homeostasis and prevent infections, the immune- and nervous system in these organs cooperate to sense and eliminate (harmful) microbes. Recognition of microbial components or products by receptors expressed on cells from the immune and nervous system can activate immune responses but may also cause pain. We review the microbial compounds and their receptors that could be involved in visceral pain development.
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Affiliation(s)
- I A M van Thiel
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, location AMC, Meibergdreef 69, 1105 BK Amsterdam, the Netherlands
| | - S Botschuijver
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, location AMC, Meibergdreef 69, 1105 BK Amsterdam, the Netherlands
| | - W J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, location AMC, Meibergdreef 69, 1105 BK Amsterdam, the Netherlands
| | - J Seppen
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, location AMC, Meibergdreef 69, 1105 BK Amsterdam, the Netherlands.
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Konthapakdee N, Grundy L, O'Donnell T, Garcia‐Caraballo S, Brierley SM, Grundy D, Daly DM. Serotonin exerts a direct modulatory role on bladder afferent firing in mice. J Physiol 2019; 597:5247-5264. [DOI: 10.1113/jp278751] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- N. Konthapakdee
- Department of PhysiologyFaculty of SciencePrince of Songkla University Hat Yai Songkhla 90112 Thailand
| | - L. Grundy
- Visceral Pain Research GroupCentre for NeuroscienceCollege of Medicine and Public HealthFlinders University Bedford Park South Australia 5042 Australia
- Hopwood Centre for NeurobiologyLifelong Health ThemeSouth Australian Health and Medical Research Institute (SAHMRI) North Terrace Adelaide South Australia 5000 Australia
- Centre for Nutrition and Gastrointestinal DiseasesDiscipline of MedicineUniversity of Adelaide North Terrace Adelaide South Australia 5000 Australia
| | - T. O'Donnell
- Visceral Pain Research GroupCentre for NeuroscienceCollege of Medicine and Public HealthFlinders University Bedford Park South Australia 5042 Australia
- Hopwood Centre for NeurobiologyLifelong Health ThemeSouth Australian Health and Medical Research Institute (SAHMRI) North Terrace Adelaide South Australia 5000 Australia
- Centre for Nutrition and Gastrointestinal DiseasesDiscipline of MedicineUniversity of Adelaide North Terrace Adelaide South Australia 5000 Australia
| | - S. Garcia‐Caraballo
- Visceral Pain Research GroupCentre for NeuroscienceCollege of Medicine and Public HealthFlinders University Bedford Park South Australia 5042 Australia
- Hopwood Centre for NeurobiologyLifelong Health ThemeSouth Australian Health and Medical Research Institute (SAHMRI) North Terrace Adelaide South Australia 5000 Australia
- Centre for Nutrition and Gastrointestinal DiseasesDiscipline of MedicineUniversity of Adelaide North Terrace Adelaide South Australia 5000 Australia
| | - S. M. Brierley
- Visceral Pain Research GroupCentre for NeuroscienceCollege of Medicine and Public HealthFlinders University Bedford Park South Australia 5042 Australia
- Hopwood Centre for NeurobiologyLifelong Health ThemeSouth Australian Health and Medical Research Institute (SAHMRI) North Terrace Adelaide South Australia 5000 Australia
- Centre for Nutrition and Gastrointestinal DiseasesDiscipline of MedicineUniversity of Adelaide North Terrace Adelaide South Australia 5000 Australia
| | - D. Grundy
- Department of Biomedical ScienceUniversity of Sheffield Sheffield UK
| | - D. M. Daly
- University of Central Lancashire Preston UK
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14
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Cao N, Huang J, Ni J, Si J, Gu B, Wang Z, Andersson KE. Streptozotocin-induced diabetes causes upregulation of serotonin (5-HT)2A/C receptors in lumbosacral cord motoneurons and down regulation of serotonergic paraneurons in the urethra. Brain Res 2019; 1715:21-26. [DOI: 10.1016/j.brainres.2019.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/12/2023]
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15
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Coelho A, Charrua A, Oliveira R, Cavaleiro H, Cruz CD, Cruz F. Underactive bladder in aging rats is associated with a reduced number of serotonin‐expressing cells in the urethra and is improved by serotonin application to the urethra. Low Urin Tract Symptoms 2019; 11:248-254. [DOI: 10.1111/luts.12273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Ana Coelho
- Department of Biomedicine – Unit of Experimental BiologyFaculty of Medicine of University of Porto Porto Portugal
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
| | - Ana Charrua
- Department of Biomedicine – Unit of Experimental BiologyFaculty of Medicine of University of Porto Porto Portugal
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
| | - Raquel Oliveira
- Department of Biomedicine – Unit of Experimental BiologyFaculty of Medicine of University of Porto Porto Portugal
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
| | - Helena Cavaleiro
- Department of Biomedicine – Unit of Experimental BiologyFaculty of Medicine of University of Porto Porto Portugal
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
| | - Célia D. Cruz
- Department of Biomedicine – Unit of Experimental BiologyFaculty of Medicine of University of Porto Porto Portugal
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
| | - Francisco Cruz
- I3S – Institute of Investigation and Innovation in HealthUniversity of Porto Porto Portugal
- IBMC – Institute of Cellular and Molecular BiologyUniversity of Porto Porto Portugal
- Department of SurgeryFaculty of Medicine of University of Porto Porto Portugal
- Department of UrologyHospital Centre S. João Porto Portugal
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16
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Birder LA. Pathophysiology of interstitial cystitis. Int J Urol 2019; 26 Suppl 1:12-15. [DOI: 10.1111/iju.13985] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Lori A Birder
- Departments of Medicine and Pharmacology and Chemical Biology University of Pittsburgh Pittsburgh Pennsylvania USA
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17
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Ikeda Y, Wolf-Johnston A, Roppolo JR, Buffington CAT, Birder L. Feline Interstitial Cystitis Enhances Mucosa-Dependent Contractile Responses to Serotonin. Int Neurourol J 2018; 22:246-251. [PMID: 30599495 PMCID: PMC6312968 DOI: 10.5213/inj.1836276.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether responses to serotonin are altered in bladder strips from cats diagnosed with a naturally occurring form of bladder pain syndrome/interstitial cystitis termed feline interstitial cystitis (FIC). METHODS Full thickness bladder strips were isolated from aged matched healthy control cats and cats with clinically verified FIC. Bladder strips were mounted in an organ bath and connected to a tension transducer to record contractile activity. A serotonin dose response (0.01-10μM) was determined for each strip with the mucosa intact or denuded. RESULTS Bladder strips from control and FIC cats contracted in response to serotonin in a dose-dependent manner. The normalized force of serotonin-evoked contractions was significantly greater in bladder strips from cats with FIC (n=7) than from control cats (n=4). Removal of the mucosa significantly decreased serotonin-mediated responses in both control and FIC bladder preparations. Furthermore, the contractions in response to serotonin were abolished by 1μM atropine in both control and FIC bladder strips. CONCLUSION The effect of serotonin on contractile force, but not sensitivity, was potentiated in bladder strips from cats with FIC, and was dependent upon the presence of the mucosa in control and FIC groups. As atropine inhibited these effects of serotonin, we hypothesize that, serotonin enhances acetylcholine release from the mucosa of FIC cat bladder strips, which could account for the increased force generated. In summary, FIC augments the responsiveness of bladder to serotonin, which may contribute to the symptoms associated with this chronic condition.
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Affiliation(s)
- Youko Ikeda
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda Wolf-Johnston
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James R. Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Birder
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Eggermont M, De Wachter S, Eastham J, Gillespie J. Innervation of the Epithelium and Lamina Propria of the Urethra of the Female Rat. Anat Rec (Hoboken) 2018; 302:201-214. [DOI: 10.1002/ar.23937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Monica Eggermont
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Stefan De Wachter
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Jane Eastham
- Uro‐physiology Research Group, The Dental and Medical SchoolNewcastle University Newcastle upon Tyne UK
| | - James Gillespie
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
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19
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Chang HH, Yeh JC, Mao J, Ginsberg DA, Ghoniem G, Rodriguez LV. Spinal cord stimulation ameliorates detrusor over-activity and visceromotor pain responses in rats with cystitis. Neurourol Urodyn 2018; 38:116-122. [PMID: 30411810 DOI: 10.1002/nau.23827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 01/07/2023]
Abstract
AIM Interstitial cystitis/painful bladder syndrome/(IC/PBS) results in recurring pain in the bladder and surrounding pelvic region caused by abnormal excitability of micturition reflexes. Spinal cord stimulation (SCS) is currently clinically used for the attenuation of neuropathic and visceral pain. The present study examined whether SCS at upper lumbar segments modulates detrusor overactivity and visceral hyperalgesia associated with cystitis in a rat model of cyclophosphamide (CYP)-induced cystitis. METHODS Cystitis was induced by intraperitoneal injection of CYP (200 mg/kg) in six adult female Sprague Dawley rats 48 h prior to urodynamic recordings. Another six rats served as-controls with saline injection. Cystometry and the external urethral sphincter (EUS) electromyography during bladder infusion were evaluated under urethane anesthesia. The visceromotor reflexes (VMR) obtained from the external abdominal oblique muscle were quantified during bladder infusion and isotonic bladder distension (IBD), respectively. After baseline recordings were taken, SCS was applied on the dorsal surface of L3 for 25 min. Urodynamic recordings and VMR during bladder infusion and IBD were repeated 2 h after SCS. RESULTS CYP resulted in detrusor overactivity, stronger EUS tonic contractions, and increased VMR. SCS significantly reduced non-voiding contractions, prolonged EUS relaxation, and delayed VMR appearance during bladder infusion as well as significantly decreased VMR during IBD in cystitis rats. CONCLUSION SCS improved bladder function and EUS relaxation during bladder infusion and significantly attenuated visceral nociceptive-related VMR during IBD in cystitis rats. SCS may have therapeutic potential for patients with hyperalgesia and IC/PBS.
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Affiliation(s)
- Huiyi H Chang
- Department of Urology, University of California Irvine, Irvine, California.,Reeve-Irvine Research Center, University of California Irvine, Irvine, California
| | - Jih-Chao Yeh
- Department of Urology, University of Southern California, Los Angeles, California
| | - Jackie Mao
- Department of Urology, University of Southern California, Los Angeles, California
| | - David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Gamal Ghoniem
- Department of Urology, University of California Irvine, Irvine, California
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California
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20
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Birder LA, Kullmann FA. Role of neurogenic inflammation in local communication in the visceral mucosa. Semin Immunopathol 2018; 40:261-279. [PMID: 29582112 PMCID: PMC5960632 DOI: 10.1007/s00281-018-0674-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 12/27/2022]
Abstract
Intense research has focused on the involvement of the nervous system in regard to cellular mechanisms underlying neurogenic inflammation in the pelvic viscera. Evidence supports the neural release of inflammatory factors, trophic factors, and neuropeptides in the initiation of inflammation. However, more recently, non-neuronal cells including epithelia, endothelial, mast cells, and paraneurons are likely important participants in nervous system functions. For example, the urinary bladder urothelial cells are emerging as key elements in the detection and transmission of both physiological and nociceptive stimuli in the lower urinary tract. There is mounting evidence that these cells are involved in sensory mechanisms and can release mediators. Further, localization of afferent nerves next to the urothelium suggests these cells may be targets for transmitters released from bladder nerves and that chemicals released by urothelial cells may alter afferent excitability. Modifications of this type of communication in a number of pathological conditions can result in altered release of epithelial-derived mediators, which can activate local sensory nerves. Taken together, these and other findings highlighted in this review suggest that neurogenic inflammation involves complex anatomical and physiological interactions among a number of cell types in the bladder wall. The specific factors and pathways that mediate inflammatory responses in both acute and chronic conditions are not well understood and need to be further examined. Elucidation of mechanisms impacting on these pathways may provide insights into the pathology of various types of disorders involving the pelvic viscera.
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Affiliation(s)
- Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
- Department of Chemical Biology and Pharmacology, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
| | - F Aura Kullmann
- Department of Medicine, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
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21
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Kullmann FA, McDonnell BM, Wolf-Johnston AS, Lynn AM, Giglio D, Getchell SE, Ruiz WG, Zabbarova IV, Ikeda Y, Kanai AJ, Roppolo JR, Bastacky SI, Apodaca G, Buffington CAT, Birder LA. Inflammation and Tissue Remodeling in the Bladder and Urethra in Feline Interstitial Cystitis. Front Syst Neurosci 2018; 12:13. [PMID: 29706873 PMCID: PMC5908978 DOI: 10.3389/fnsys.2018.00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 01/21/2023] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease of unknown etiology. A naturally occurring disease termed feline interstitial cystitis (FIC) reproduces many features of IC/BPS patients. To gain insights into mechanisms underlying IC/BPS, we investigated pathological changes in the lamina propria (LP) of the bladder and proximal urethra in cats with FIC, using histological and molecular methods. Compared to control cat tissue, we found an increased number of de-granulated mast cells, accumulation of leukocytes, increased cyclooxygenase (COX)-1 expression in the bladder LP, and increased COX-2 expression in the urethra LP from cats with FIC. We also found increased suburothelial proliferation, evidenced by mucosal von Brunn’s nests, neovascularization and alterations in elastin content. Scanning electron microscopy revealed normal appearance of the superficial urethral epithelium, including the neuroendocrine cells (termed paraneurons), in FIC urethrae. Together, these histological findings suggest the presence of chronic inflammation of unknown origin leading to tissue remodeling. Since the mucosa functions as part of a “sensory network” and urothelial cells, nerves and other cells in the LP are influenced by the composition of the underlying tissues including the vasculature, the changes observed in the present study may alter the communication of sensory information between different cellular components. This type of mucosal signaling can also extend to the urethra, where recent evidence has revealed that the urethral epithelium is likely to be part of a signaling system involving paraneurons and sensory nerves. Taken together, our data suggest a more prominent role for chronic inflammation and tissue remodeling than previously thought, which may result in alterations in mucosal signaling within the urinary bladder and proximal urethra that may contribute to altered sensations and pain in cats and humans with this syndrome.
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Affiliation(s)
- F Aura Kullmann
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bronagh M McDonnell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda S Wolf-Johnston
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew M Lynn
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel Giglio
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Samuel E Getchell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Wily G Ruiz
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Irina V Zabbarova
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Youko Ikeda
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony J Kanai
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheldon I Bastacky
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gerard Apodaca
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - C A Tony Buffington
- Department of Medicine and Epidemiology, University of California, Davis, Davis, CA, United States.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Lori A Birder
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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