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Liang CC, Hsieh WC, Lo TS, Huang TX, Chou YC, Huang JY, Huang YH. Urinary beta 3-adrenoceptor as a diagnostic biomarker for overactive bladder in women. Sci Rep 2023; 13:19368. [PMID: 37938600 PMCID: PMC10632490 DOI: 10.1038/s41598-023-46786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/05/2023] [Indexed: 11/09/2023] Open
Abstract
This study was to investigate urinary beta 3-adrenoceptor concentration as a biomarker for overactive bladder (OAB) and predictor of treatment outcomes in women receiving the beta 3-adrenoceptor agonist mirabegron. The study comprised 50 women identified with OAB and 35 women considered as healthy controls. All women with OAB received daily dosage of 50 mg of mirabegron for 12 weeks. Bladder diaries, OAB-related questionnaires, and global response assessment scale (GRAS) data were collected. Urinary beta 3-adrenoceptor concentration was measured through enzyme-linked immunosorbent assay. All OAB-related questionnaires and GRAS indicated improved posttreatment urinary health. After mirabegron treatment, the frequency of micturition and urgency episodes decreased, but the urinary beta 3-adrenoceptor/creatinine (Cr) ratio increased. The urinary beta 3-adrenoceptor/creatinine ratio was identified as a sensitive biomarker for OAB with a confidence interval of 0.656 to 0.856 (p < 0.001). A negative correlation (- 0.431, p = 0.040) between this biomarker and health-related quality of life (HRQL) scores. The Beta 3-adrenoceptor/Cr levels increased significantly in the treatment-responsive group, while they remained unchanged in the unsatisfactory outcome group. This study shows that 12 weeks of mirabegron treatment improves OAB symptoms and HRQL. Furthermore, urinary beta 3-adrenoceptor concentration may be a diagnostic biomarker for OAB.
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Affiliation(s)
- Ching-Chung Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Xuan Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Yi-Chun Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
| | - Jing-Yi Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Hsin Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan
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2
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Huang R, Tamalunas A, Waidelich R, Strittmatter F, Stief CG, Hennenberg M. Inhibition of full smooth muscle contraction in isolated human detrusor tissues by mirabegron is limited to off-target inhibition of neurogenic contractions. J Pharmacol Exp Ther 2022; 381:176-187. [DOI: 10.1124/jpet.121.001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/08/2022] [Indexed: 11/22/2022] Open
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3
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Offiah I, Drake MJ, Gammie A. Implications of Underactive Bladder Syndrome for Nocturia. Do We Need Urodynamic Assessment? Eur Urol Focus 2022; 8:86-88. [PMID: 35027332 DOI: 10.1016/j.euf.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ifeoma Offiah
- Department of Urogynaecology, Southmead Hospital, Bristol, UK.
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
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4
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Wu WY, Lee SP, Chiang BJ, Lin WY, Chien CT. Urothelial Calcium-Sensing Receptor Modulates Micturition Function via Mediating Detrusor Activity and Ameliorates Bladder Hyperactivity in Rats. Pharmaceuticals (Basel) 2021; 14:ph14100960. [PMID: 34681183 PMCID: PMC8537609 DOI: 10.3390/ph14100960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
The urothelium displays mechano- and chemosensory functions via numerous receptors and channels. The calcium-sensing receptor (CaSR) detects extracellular calcium and modulates several physiological functions. Nonetheless, information about the expression and the role of CaSR in lower urinary tract has been absent. We aimed to determine the existence of urothelial CaSR in urinary bladder and its effect on micturition function. We utilized Western blot to confirm the expression of CaSR in bladder and used immunofluorescence to verify the location of the CaSR in the bladder urothelium via colocalization with uroplakin III A. The activation of urothelial CaSR via the CaSR agonist, AC-265347 (AC), decreased urinary bladder smooth muscle (detrusor) activity, whereas its inhibition via the CaSR antagonist, NPS-2143 hydrochloride (NPS), increased detrusor activity in in vitro myography experiments. Cystometry, bladder nerve activities recording, and bladder surface microcirculation detection were conducted to evaluate the effects of the urothelial CaSR via intravesical administrations. Intravesical AC inhibited micturition reflex, bladder afferent and efferent nerve activities, and reversed cystitis-induced bladder hyperactivity. The urothelial CaSR demonstrated a chemosensory function, and modulated micturition reflex via regulating detrusor activity. This study provided further evidence of how the urothelial CaSR mediated micturition and implicated the urothelial CaSR as a potential pharmacotherapeutic target in the intervention of bladder disorders.
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Affiliation(s)
- Wei-Yi Wu
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei 11677, Taiwan;
| | - Shih-Pin Lee
- Department of Public Health, International College, Krirk University, Bangkok 10220, Thailand;
| | - Bing-Juin Chiang
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei 11677, Taiwan;
- College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
- Correspondence: (B.-J.C.); (W.-Y.L.); (C.-T.C.); Tel.: +886-2-77496312 (C.-T.C.)
| | - Wei-Yu Lin
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei 11677, Taiwan;
- Department of Urology, Ministry of Health and Welfare, Taipei Hospital, New Taipei City 24213, Taiwan
- Correspondence: (B.-J.C.); (W.-Y.L.); (C.-T.C.); Tel.: +886-2-77496312 (C.-T.C.)
| | - Chiang-Ting Chien
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei 11677, Taiwan;
- Correspondence: (B.-J.C.); (W.-Y.L.); (C.-T.C.); Tel.: +886-2-77496312 (C.-T.C.)
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5
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Effects of β3-adrenoceptor agonist on acute urinary retention in a rat model. World J Urol 2021; 39:4427-4433. [PMID: 34304275 DOI: 10.1007/s00345-021-03774-7] [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: 05/05/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the protective effect of mirabegron on bladder dysfunction in an acute urinary retention rat model. MATERIALS AND METHODS Thirty-six 16-week Sprague-Dawley rats were assigned to the mirabegron and normal saline (N/S) groups. Each group of eighteen was divided into sub-groups of 6 for 30 min, 2 h, and 24 h. They were administered mirabegron (10 mg/kg) and N/S daily for 4 weeks, respectively. Mirabegron and N/S groups were divided into sub-groups of 6 rats for 30 min, 2 h, and 24 h. The changes in bladder blood flow were measured using laser Doppler (moorVMS-LDF2). Histopathological examination of the bladder and nitric oxide (NO) measurement were performed. RESULT During the urinary retention phase in the mirabegron group, it showed higher and rapider recovery of blood flow; the lowest at 19.5% ± 3.68% at 3 min, a significant recovery from the lowest value as 23.7 ± 3.4% at 10 min, than that in the N/S group; 15.1 ± 1.84% at 5 min, 23.7 ± 3.4% at 20 min, respectively (P < 0.05). At 30 min, 120 min, and 24 h after reperfusion, the recovery of blood flow in the mirabegron group was significantly higher than that in the N/S group (mirabegron: 41.1 ± 1.7%, 59.9 ± 7.2%, and 89.7 ± 4.4%, N/S: 31.3 ± 2.1%, 47.3 ± 4.5%, 83.9 ± 3.6%, respectively (P < 0.05)). NO levels tended to be higher in the mirabegron group; however, the difference was not statistically significant. Histological examination revealed that the mirabegron group showed recovery close to normal tissue after 24 h. CONCLUSIONS In an acute urinary retention rat model, mirabegron maintained and restored higher bladder blood flow, resulting in protective and recovery effect after acute urinary retention.
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Peng HY, Lai CY, Hsieh MC, Lin TB. Solifenacin/Mirabegron Induces an Acute Compliance Increase in the Filling Phase of the Capacity-Reduced Urinary Bladder: A Pressure-Volume Analysis in Rats. Front Pharmacol 2021; 12:657959. [PMID: 34122078 PMCID: PMC8188241 DOI: 10.3389/fphar.2021.657959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/23/2021] [Indexed: 01/28/2023] Open
Abstract
Aims: Pressure in the bladder, which is a high compliance organ, is only slightly elevated to a considerable filling volume during storage. Although cystometry off-line offers mean compliance, no protocol is available for real-time assays of the dynamics of bladder compliance, and the potential impact of solifenacin and mirabegron on dynamic bladder compliance has not been established. Methods: Along with constantly infused cystometry, a pressure-volume analysis (PVA) was performed by plotting intra-vesical volume against pressure in Sprague-Dawley rats. The instant compliance was assayed as the slope of the trajectory, and the mean compliance (Cm) was determined by the slope of the line produced by regression of the data points at the end of the first, second, and third quarters of the filling phase. Results: Under a steady-state, the PVA trajectory moved clockwise which shaped coincident enclosed loops with stable compliance. Though administering to naïve animals solifenacin, but not mirabegron (both 1 × 10−5−1 × 10−1 mg/kg, i.a.) decreased the peak pressure, both of these reagents exhibited acute increments in the trajectory slope and Cm of the filling phase in a dose-dependent manner (ED50 = 1.4 × 10−4 and 2.2 × 10−5 mg/kg, respectively). Resembling urine frequency/urgency in OAB patients, the voiding frequency of a capacity-reduced bladder was increased in association with decreased compliance which was ameliorated by both acute solifenacin and mirabegron injections (both 1 × 10−1 mg/kg). Conclusion: In addition to their well-known anti-inotropic/relaxative effects, solifenacin, and mirabegron induce an acute increase in bladder compliance to ameliorate OAB-like syndromes. Together with time-domain cystometry, PVA offers a platform for investigating the physiology/pathophysiology/pharmacology of bladder compliance which is crucial for urine storage.
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Affiliation(s)
- Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Cheng-Yuan Lai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ming-Chun Hsieh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tzer-Bin Lin
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.,Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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7
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Liang CC, Shaw SWS, Ko YS, Huang YH, Lee TH. Effect of amniotic fluid stem cell transplantation on the recovery of bladder dysfunction in spinal cord-injured rats. Sci Rep 2020; 10:10030. [PMID: 32572272 PMCID: PMC7308393 DOI: 10.1038/s41598-020-67163-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
The effects of human amniotic fluid stem cell (hAFSC) transplantation on bladder function and molecular changes in spinal cord-injured (SCI) rats were investigated. Four groups were studied: sham and SCI plus phosphate-buffered saline (SCI + PBS), human embryonic kidney 293 (HEK293) cells, and hAFSCs transplantation. In SCI + PBS rat bladders, cystometry showed increased peak voiding pressure, voiding volume, bladder capacity, residual volume, and number of non-voiding contractions, and the total elastin/collagen amount was increased but collagen concentration was decreased at days 7 and 28. Immunoreactivity and mRNA levels of IGF-1, TGF-β1, and β3-adrenoceptor were increased at days 7 and/or 28. M2 immunoreactivity and M3 mRNA levels of muscarinic receptor were increased at day 7. M2 immunoreactivity was increased, but M2/M3 mRNA and M3 immunoreactivity levels were decreased at day 28. Brain derived-neurotrophic factor mRNA was increased, but immunoreactivity was decreased at day 7. HEK293 cell transplantation caused no difference compared to SCI + PBS group. hAFSCs co-localized with neural cell markers and expressed BDNF, TGF-β1, GFAP, and IL-6. The present results showed that SCI bladders released IGF-1 and TGF-β1 to stimulate elastin and collagen for bladder wall remodelling, and hAFSC transplantation improved these changes, which involved the mechanisms of BDNF, muscarinic receptors, and β3-adrenoceptor expression.
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Affiliation(s)
- Ching-Chung Liang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Wen Steven Shaw
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Obstetrics, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Prenatal Cell and Gene Therapy Group, Institute for Women's Health, University College London, London, UK
| | - Yu-Shien Ko
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,The First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yung-Hsin Huang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
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8
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In Vitro Effects of Plasma Collected From Rats Administered Naftopidil on Whole Urinary Bladder Preparation Isolated From Rats. Int Neurourol J 2020; 23:277-286. [PMID: 31905274 PMCID: PMC6944793 DOI: 10.5213/inj.1938102.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/29/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose Alpha-1-adrenoceptor blockers (e.g., naftopidil) are prescribed for the treatment of male lower urinary tract symptoms. Although the mechanism of action of naftopidil has been studied in various organs, that in the urinary bladder remains unknown. To clarify the direct effects of naftopidil on this organ, activities were assessed in the isolated rat whole urinary bladder. Methods A total of 30 female rats were used. In Experiment 1, bladder activity was measured during a cumulative administration of 2.5–75μM naftopidil (n=7). In Experiment 2, rats were divided into 2 groups: control (n=10) and naftopidil (5 mg/animal/day, oral gavage, once-daily for 2 weeks) (n=13). After the treatment period, plasma was obtained from each rat. The urinary bladders were harvested from the control rats. Isovolumetric rhythmic bladder contractions were induced at above the threshold volume, and intravesical pressure was recorded. Control plasma was added to the organ bath; after subsequent wash-out, plasma collected from rats administered naftopidil was added. In Experiment 3, the plasma levels of monoamines and amino acids were quantified using the individual plasma prepared in the Experiment 2. Results Cumulative dosing with naftopidil did not change the interval between spontaneous contractions compared to the interval at baseline. After adding control plasma, the interval was shortened compared to the baseline (P=0.008). The plasma collected from rats administered naftopidil suppressed the shortening of the interval compared to the control plasma (P=0.041). Naftopidil resulted in a decrease in the level of noradrenaline (P=0.009) and an increase in that of glycine (P=0.014). Conclusions Although naftopidil did not directly act on the interval between spontaneous contractions of the urinary bladder, the plasma collected from rats administered naftopidil, with changing levels of monoamines and amino acids, may suppressed shortening the interval.
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Effects of the combination of vibegron and imidafenacin on bladder function in urethane-anesthetized rats. Eur J Pharmacol 2019; 864:172727. [DOI: 10.1016/j.ejphar.2019.172727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022]
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10
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Igawa Y, Aizawa N, Michel MC. β 3 -Adrenoceptors in the normal and diseased urinary bladder-What are the open questions? Br J Pharmacol 2019; 176:2525-2538. [PMID: 30868554 DOI: 10.1111/bph.14658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/31/2018] [Accepted: 01/29/2019] [Indexed: 12/13/2022] Open
Abstract
β3 -Adrenoceptor agonists are used in the treatment of overactive bladder syndrome. Although the relaxant response to adrenergic stimulation in human detrusor smooth muscle cells is mediated mainly via β3 -adrenoceptors, the plasma concentrations of the therapeutic dose of mirabegron, the only clinically approved β3 -adrenoceptor agonist, are considerably lower than the EC50 for causing direct relaxation of human detrusor, suggesting a mechanism of action other than direct relaxation of detrusor smooth muscle. However, the site and mechanism of action of β3 -adrenoceptor agonists in the bladder have not been firmly established. Postulated mechanisms include prejunctional suppression of ACh release from the parasympathetic nerves during the storage phase and inhibition of micro-contractions through β3 -adrenoceptors on detrusor smooth muscle cells or suburothelial interstitial cells. Implications of possible desensitization of β3 -adrenoceptors in the bladder upon prolonged agonist exposure and possible causes of rarely observed cardiovascular effects of mirabegron are also discussed. LINKED ARTICLES: This article is part of a themed section on Adrenoceptors-New Roles for Old Players. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.14/issuetoc.
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Affiliation(s)
- Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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11
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Ito H, Chakrabarty B, Drake MJ, Fry CH, Kanai AJ, Pickering AE. Sildenafil, a phosphodiesterase type 5 inhibitor, augments sphincter bursting and bladder afferent activity to enhance storage function and voiding efficiency in mice. BJU Int 2019; 124:163-173. [PMID: 30636087 PMCID: PMC6579678 DOI: 10.1111/bju.14664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives To investigate the influence of low‐dose sildenafil, a phosphodiesterase type 5 inhibitor (PDE5‐I), on the function of the mouse lower urinary tract (LUT). Materials and Methods Adult male mice were decerebrated and arterially perfused with a carbogenated Ringer's solution to establish the decerebrate arterially perfused mouse (DAPM). To allow distinction between central neural and peripheral actions of sildenafil, experiments were conducted in both the DAPM and in a ‘pithed’ DAPM, which has no functional brainstem or spinal cord. The action of systemic and intrathecal sildenafil on micturition was assessed in urethane‐anaesthetised mice. Results In the DAPM, systemic perfusion of sildenafil (30 pm) decreased the voiding threshold pressure [to a mean (sem) 84.7 (3.8)% of control] and increased bladder compliance [to a mean (sem) 140.2 (8.3)% of control, an effect replicated in the pithed DAPM]. Sildenafil was without effect on most voiding variables but significantly increased the number of bursts of the external urethral sphincter (EUS) per void in DAPM [to a mean (sem) 130.1 (6.9)% of control at 30 pm] and in urethane‐anaesthetised mice [to a mean (sem) 117.5 (5.8)% of control at 14 ng/kg]. Sildenafil (10 and 30 pm) increased pelvic afferent activity during both bladder filling and the isovolumetric phase [to a mean (sem) 205.4 (30.2)% of control at 30 pm]. Intrathecal application of sildenafil (5 μL of either 150 pm or 1.5 nm) did not alter cystometry and EUS‐electromyography variables in urethane‐anaesthetised mice. Conclusions Low‐dose sildenafil increases bladder compliance, increases pelvic nerve afferent activity, and augments the bursting activity of the EUS. We propose that the novel actions on afferent traffic and sphincter control may contribute to its beneficial actions to restore storage and voiding efficiency in LUT dysfunction.
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Affiliation(s)
- Hiroki Ito
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
| | - Basu Chakrabarty
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
| | - Marcus J Drake
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK.,Bristol Medical School and Bristol Urological Institute, Bristol, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
| | - Anthony J Kanai
- Department of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK.,Bristol Anaesthetic, Pain and Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Chakrabarty B, Bijos DA, Vahabi B, Clavica F, Kanai AJ, Pickering AE, Fry CH, Drake MJ. Modulation of Bladder Wall Micromotions Alters Intravesical Pressure Activity in the Isolated Bladder. Front Physiol 2019; 9:1937. [PMID: 30687132 PMCID: PMC6335571 DOI: 10.3389/fphys.2018.01937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022] Open
Abstract
Micromotions are phasic contractions of the bladder wall. During urine storage, such phasic activity has little effect on intravesical pressure, however, changed motile activity may underlie urodynamic observations such as detrusor overactivity. The potential for bladder motility to affect pressure reflects a summation of the overall movements, comprising the initiation, propagation, and dissipation components of micromotions. In this study, the influence of initiation of micromotions was investigated using calcium activated chloride channel blocker niflumic acid, and the effect of propagation using blockers of gap junctions. The overall bladder tone was modulated using isoprenaline. Isolated tissue strips and whole bladder preparations from juvenile rats were used. 18β-glycyrrhetinic acid was used to block gap junctions, reducing the amplitude and frequency of micromotions in in vitro and ex vivo preparations. Niflumic acid reduced the frequency of micromotions but had no effect on the amplitude of pressure fluctuations. Isoprenaline resulted in a reduction in pressure fluctuations and a decrease in pressure baseline. Using visual video data analysis, bladder movement was visible, irrespective of lack of pressure changes, which persisted during bladder relaxation. However, micromotions propagated over shorter distances and the overall bladder tone was reduced. All these results suggest that phasic activity of the bladder can be characterised by a combination of initiation and propagation of movement, and overall bladder tone. At any given moment, intravesical pressure recordings are an integration of these parameters. This synthesis gives insight into the limitations of clinical urodynamics, where intravesical pressure is the key indicator of detrusor activity.
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Affiliation(s)
- Basu Chakrabarty
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Dominika A Bijos
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
| | - Bahareh Vahabi
- Department of Applied Sciences, University of West England, Bristol, Bristol, United Kingdom
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
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13
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Mossa A, Velasquez Flores M, Nguyen H, Cammisotto PG, Campeau L. Beta-3 Adrenoceptor Signaling Pathways in Urothelial and Smooth Muscle Cells in the Presence of Succinate. J Pharmacol Exp Ther 2018; 367:252-259. [PMID: 30104323 DOI: 10.1124/jpet.118.249979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/08/2018] [Indexed: 12/27/2022] Open
Abstract
Succinate, an intermediate metabolite of the Krebs cycle, can alter the metabolomics response to certain drugs and controls an array of molecular responses in the urothelium through activation of its receptor, G-protein coupled receptor 91 (GPR91). Mirabegron, a β3-adrenergic receptor (β3-AR) agonist used to treat overactive bladder syndrome (OAB), increases intracellular cAMP in the detrusor smooth muscle cells (SMC), leading to relaxation. We have previously shown that succinate inhibits forskolin-stimulated cAMP production in urothelium. To determine whether succinate interferes with mirabegron-mediated bladder relaxation, we examined their individual and synergistic effect in urothelial-cell and SMC signaling. We first confirmed β3-AR involvement in the mirabegron response by quantifying receptor abundance by immunoblotting in cultured urothelial cells and SMC and cellular localization by immunohistochemistry in rat bladder tissue. Mirabegron increased cAMP levels in SMC but not in urothelial cells, an increase that was inhibited by succinate, suggesting that it impairs cAMP-mediated bladder relaxation by mirabegron. Succinate and mirabegron increased inducible nitric oxide synthesis and nitric oxide secretion only in urothelial cells, suggesting that its release can indirectly induces SMC relaxation. Succinate exposure decreased the expression of β3-AR protein in whole bladder in vivo and in SMC in vitro, indicating that this metabolite may lead to impaired pharmacodynamics of the bladder. Together, our results demonstrate that increased levels of succinate in settings of metabolic stress (e.g., the metabolic syndrome) may lead to impaired mirabegron and β3-AR interaction, inhibition of cAMP production, and ultimately requiring mirabegron dose adjustment for its treatment of OAB related to these conditions.
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Affiliation(s)
- Abubakr Mossa
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
| | | | - Hieu Nguyen
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
| | | | - Lysanne Campeau
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
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14
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Andersson KE, Choudhury N, Cornu JN, Huang M, Korstanje C, Siddiqui E, Van Kerrebroeck P. The efficacy of mirabegron in the treatment of urgency and the potential utility of combination therapy. Ther Adv Urol 2018; 10:243-256. [PMID: 30034543 PMCID: PMC6048625 DOI: 10.1177/1756287218781255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/29/2018] [Indexed: 01/23/2023] Open
Abstract
Urgency is the prevalent and most bothersome symptom of overactive bladder (OAB) and the treatment of urgency is the primary objective in the management of OAB. Urgency has a major impact on other symptoms of OAB and culminates in an increased frequency of micturition and reduced volume voided, which may contribute to shorter intervals between the need to void. Antimuscarinic agents and mirabegron, a β3-adrenoceptor agonist, constitute the main oral pharmacotherapeutic options for the treatment of urgency and other OAB symptoms. The reduction of urgency and other OAB symptoms significantly improve health-related quality of life. This review will explore the distinct mechanisms of action and effects of antimuscarinic agents and mirabegron, in relation to their effect on the pathophysiology of urgency. The review will also provide an overview of the various validated measurements of urgency and the numerous clinical trials regarding antimuscarinic agent monotherapy, mirabegron monotherapy, or combination treatment with mirabegron added on to the antimuscarinic agent solifenacin. A narrative review of the literature relating to pathophysiology of urgency, the validated measurements of urgency, and clinical trials relating to the pharmacological treatment of urgency. Antimuscarinic agent monotherapy, mirabegron monotherapy, or combination treatment with mirabegron added on to the antimuscarinic agent solifenacin statistically significantly reduce the symptoms of urgency compared with placebo. Combination therapy with mirabegron added on to solifenacin also statistically significantly reduces the symptoms of severe urgency compared with antimuscarinic agent monotherapy. A critique of the clinical benefits of combination therapy is also provided. Combination therapy provides an alternative treatment in patients with OAB that includes urgency who respond poorly to first-line monotherapy and who may otherwise often move on to more invasive treatments.
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Affiliation(s)
- Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA Aarhus Institute for Advanced Sciences (AIAS), Aarhus University, Aarhus, Denmark
| | - Nurul Choudhury
- Astellas Pharma Europe Ltd., 2000 Hillswood Drive, Chertsey, Surrey, KT16 0RS, UK
| | - Jean-Nicolas Cornu
- Department of Urology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Moses Huang
- Astellas Pharma Europe Ltd., Chertsey, Surrey, UK
| | - Cees Korstanje
- Astellas Pharma Europe Research and Development, Leiden, The Netherlands
| | - Emad Siddiqui
- Astellas Pharma Medical and Development, Leiden, The Netherlands
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15
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Drake MJ, Fry CH, Hashitani H, Kirschner-Hermanns R, Rahnama'i MS, Speich JE, Tomoe H, Kanai AJ, McCloskey KD. What are the origins and relevance of spontaneous bladder contractions? ICI-RS 2017. Neurourol Urodyn 2018; 37:S13-S19. [PMID: 29360173 DOI: 10.1002/nau.23485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Storage phase bladder activity is a counter-intuitive observation of spontaneous contractions. They are potentially an intrinsic feature of the smooth muscle, but interstitial cells in the mucosa and the detrusor itself, as well as other muscular elements in the mucosa may substantially influence them. They are identified in several models explaining lower urinary tract dysfunction. METHODS A consensus meeting at the International Consultation on Incontinence Research Society (ICI-RS) 2017 congress considered the origins and relevance of spontaneous bladder contractions by debating which cell type(s) modulate bladder spontaneous activity, whether the methodologies are sufficiently robust, and implications for healthy and abnormal lower urinary tract function. RESULTS The identified research priorities reflect a wide range of unknown aspects. Cellular contributions to spontaneous contractions in detrusor smooth muscle are still uncertain. Accordingly, insight into the cellular physiology of the bladder wall, particularly smooth muscle cells, interstitial cells, and urothelium, remains important. Upstream influences, such as innervation, endocrine, and paracrine factors, are particularly important. The cellular interactions represent the key understanding to derive the integrative physiology of organ function, notably the nature of signalling between mucosa and detrusor layers. Indeed, it is still not clear to what extent spontaneous contractions generated in isolated preparations mirror their normal and pathological counterparts in the intact bladder. Improved models of how spontaneous contractions influence pressure generation and sensory nerve function are also needed. CONCLUSIONS Deriving approaches to robust evaluation of spontaneous contractions and their influences for experimental and clinical use could yield considerable progress in functional urology.
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Affiliation(s)
- Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Hikaru Hashitani
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Ruth Kirschner-Hermanns
- Neuro-Urology/Urology, University Clinic, Rheinische Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
| | | | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Hikaru Tomoe
- Department of Urology and Pelvic Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Anthony J Kanai
- Department of Medicine, Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen D McCloskey
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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16
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Ito H, Drake MJ, Fry CH, Kanai AJ, Pickering AE. Characterization of mouse neuro-urological dynamics in a novel decerebrate arterially perfused mouse (DAPM) preparation. Neurourol Urodyn 2018; 37:1302-1312. [PMID: 29333621 PMCID: PMC5947622 DOI: 10.1002/nau.23471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
AIM To develop the decerebrate arterially perfused mouse (DAPM) preparation, a novel voiding model of the lower urinary tract (LUT) that enables in vitro-like access with in vivo-like neural connectivity. METHODS Adult male mice were decerebrated and arterially perfused with a carbogenated, Ringer's solution to establish the DAPM. To allow distinction between central and peripheral actions of interventions, experiments were conducted in both the DAPM and in a "pithed" DAPM which has no brainstem or spinal cord control. RESULTS Functional micturition cycles were observed in response to bladder filling. During each void, the bladder showed strong contractions and the external urethral sphincter (EUS) showed bursting activity. Both the frequency and amplitude of non-voiding contractions (NVCs) in DAPM and putative micromotions (pMM) in pithed DAPM increased with bladder filling. Vasopressin (>400 pM) caused dyssynergy of the LUT resulting in retention in DAPM as it increased tonic EUS activity and basal bladder pressure in a dose-dependent manner (basal pressure increase also noted in pithed DAPM). Both neuromuscular blockade (vecuronium) and autonomic ganglion blockade (hexamethonium), initially caused incomplete voiding, and both drugs eventually stopped voiding in DAPM. Intravesical acetic acid (0.2%) decreased the micturition interval. Recordings from the pelvic nerve in the pithed DAPM showed bladder distention-induced activity in the non-noxious range which was associated with pMM. CONCLUSIONS This study demonstrates the utility of the DAPM which allows a detailed characterization of LUT function in mice.
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Affiliation(s)
- Hiroki Ito
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Marcus J Drake
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Anthony J Kanai
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, United Kingdom
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17
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Yoshida M, Nozawa Y, Kato D, Tabuchi H, Kuroishi K. Safety and effectiveness of mirabegron in patients with overactive bladder aged ≥75 years: Analysis of a Japanese post-marketing study. Low Urin Tract Symptoms 2017; 11:30-38. [PMID: 28901041 DOI: 10.1111/luts.12190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A 12-week post-marketing study was conducted to provide real-world data on Japanese patients with overactive bladder (OAB) initiating treatment with mirabegron. This post-hoc analysis focused on safety and effectiveness of mirabegron in patients aged ≥75 versus <75 years. METHODS Incidence of adverse drug reactions (ADR) was assessed following 12 weeks' mirabegron treatment. Overactive Bladder Symptom Score (OABSS) and International-Prostate Symptom Score Quality of Life (I-PSS QoL) were completed at baseline and at the end of treatment (EoT). A reduction of ≥3 points in total OABSS was defined as a minimal clinically important change (MCIC). RESULTS Of 9795 patients, a greater proportion aged ≥75 versus <75 years had a lower body mass index (BMI; BMI < 18.5: 4.2% vs 3.2%), longer OAB duration (≥3 years: 24.6% vs 20.3%) and more severe OAB symptoms (severe: 17.0% vs 11.2%). A significantly greater percentage of patients aged ≥75 versus <75 years had comorbidities (77.8% vs 66.0%) and used concomitant drugs (58.3% vs 48.7%; P < 0.001). Incidence of ADR was observed in 7.00% and 5.19% of patients aged ≥75 versus <75 years, respectively. At EoT, mirabegron treatment was reported 'effective' in 79.3% versus 82.1% of patients aged ≥75 versus <75 years, respectively. Mean total OABSS decreased significantly from baseline, and exceeded the MCIC in 61.0% and 65.9% of patients aged ≥75 and <75 years, respectively. Similar changes were observed for I-PSS QoL in both groups. CONCLUSIONS In a real-world clinical setting, mirabegron was well-tolerated and effective in patients aged ≥75 and <75 years.
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Affiliation(s)
- Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Aichi, Japan
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18
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Assessing Preference-Based Outcome Measures for Overactive Bladder: An Evaluation of Patient-Reported Outcome Data from the BESIDE Clinical Trial. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017. [PMID: 28646416 DOI: 10.1007/s40271-017-0262-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare outcomes using two preference-based measures of health status (EQ-5D-5L and OAB-5D) in patients with overactive bladder (OAB) treated with solifenacin plus mirabegron or solifenacin monotherapy in the BESIDE trial. METHODS Patients with OAB who remained incontinent after 4 weeks' treatment with solifenacin 5 mg were randomized 1:1:1 to combination treatment (solifenacin 5 mg plus mirabegron [25 mg for the first 4 weeks/50 mg for the last 8 weeks]), solifenacin 5 mg, or solifenacin 10 mg. EQ-5D-5L and OAB-q were administered at baseline, weeks 4, 8, 12, and end of treatment (EoT). OAB-5D scores were derived from OAB-q results. Responder analysis was carried out using several definitions of minimally important difference. RESULTS A total of 2054 patients received one or more doses of study treatment (combination, n = 694; solifenacin 5 mg, n = 684; solifenacin 10 mg, n = 676). EQ-5D-5L Index mean score changes (from baseline to EoT) were greater with combination (0.059) than with solifenacin 5 mg (0.040) and 10 mg (0.044) monotherapy, but the differences were not statistically significant. A significantly greater improvement was observed for combination on OAB-5D (0.107 vs 0.085 for 5 mg, and 0.087 for 10 mg; p ≤ 0.01). The dimensions most improved overall were anxiety/depression, pain/discomfort, and usual activities on EQ-5D-5L, and urge, urine loss, and coping on OAB-5D. The proportion of responders was significantly greater with combination compared with monotherapy using OAB-5D only. CONCLUSIONS Improvements were observed in all study arms on both the EQ-5D-5L and OAB-5D, although only the OAB-5D showed a statistically significant benefit for combination versus solifenacin monotherapy. Combining generic and condition-specific preference-based health status measures allowed for assessment of dimensions that were particularly relevant to this patient population, while permitting comparison with outcomes from other studies, treatments, and populations via EQ-5D.
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19
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On the Site and Mechanism of Action of β 3-Adrenoceptor Agonists in the Bladder. Int Neurourol J 2017; 21:6-11. [PMID: 28361520 PMCID: PMC5380826 DOI: 10.5213/inj.1734850.425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/20/2022] Open
Abstract
The clinical success of mirabegron as the first β3-adrenoceptor (AR) agonist for treatment of the overactive bladder (OAB) syndrome, has resulted in substantial interest in its site and mechanism of action. Even if the adrenergic innervation of the bladder and urethra has been well studied, the location(s) of β3-ARs in different structures within the bladder wall and urethra, and the mode(s) of action of β3-AR stimulation have still not been established. The recent demonstration of β3-ARs on cholinergic nerve terminals with no immunoreactivity in urothelium or detrusor smooth muscle, is not in agreement with previous morphological studies, and functional data strongly suggest that β3-ARs can be found these structures. However, recent studies suggest that the β3-ARs on detrusor smooth muscle may not be the functionally most relevant. The assumption that β3-AR activation during bladder filling inhibits acetylcholine release from parasympathetic neurons by a prejunctional mechanism and that this decreases bladder micromotions that generate afferent activity, is an attractive hypothesis. It does not exclude that other mechanisms may be contributing, and supports combined approaches to reduce afferent activity for treatment of the OAB syndrome.
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20
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Harper BH, Wang L, Zhu C, Kar NF, Li B, Moyes CR, Goble SD, Costa M, Dingley K, Di Salvo J, Ha SN, Hurley A, Li X, Miller RR, Nagabukuro H, Salituro GM, Smith S, Struthers M, Hale JJ, Edmondson SD, Berger R. Investigation of piperazine benzamides as human β 3 adrenergic receptor agonists for the treatment of overactive bladder. Bioorg Med Chem Lett 2017; 27:1094-1098. [PMID: 28089699 DOI: 10.1016/j.bmcl.2016.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 01/15/2023]
Abstract
The synthesis of a novel class of piperazine benzamide (reverse amides) targeting the human β3-adrenergic receptor for the treatment of overactive bladder (OAB) is described. The SAR studies directed towards maintaining well established β3 potency and selectivities while improving the overall pharmacokinetic profile in the reverse amide class will be evaluated. The results and consequences associated with functional activity at the norepinephrine transporter (NET) will also be discussed.
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Affiliation(s)
- Bart H Harper
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States.
| | - Liping Wang
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Cheng Zhu
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Nam F Kar
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Bing Li
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | | | - Stephen D Goble
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Melissa Costa
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Karen Dingley
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Jerry Di Salvo
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Sookhee N Ha
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Amanda Hurley
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Xiaofang Li
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Randy R Miller
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | | | - Gino M Salituro
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Sean Smith
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Mary Struthers
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Jeffrey J Hale
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Scott D Edmondson
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
| | - Richard Berger
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, United States
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21
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Ito H, Pickering AE, Igawa Y, Kanai AJ, Fry CH, Drake MJ. Muro-Neuro-Urodynamics; a Review of the Functional Assessment of Mouse Lower Urinary Tract Function. Front Physiol 2017; 8:49. [PMID: 28220079 PMCID: PMC5292568 DOI: 10.3389/fphys.2017.00049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/18/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Mouse urodynamic tests are fundamental to understanding normal lower urinary tract (LUT) function. These experiments also contribute to our understanding of neurological dysfunction, pathophysiological processes, and potential mechanisms of therapy. Objectives: Systematic assessment of published evidence on urodynamics, advantages and limitations of different urodynamic measurements in mice, and consideration of potential implications for the clinical field. Methods: A search using specific search-terms for urodynamic studies and mice was conducted on PubMed (from inception to 1 July 2016). Results: We identified 55 studies examining or describing mouse neuro-urodynamics. We summarize reported features of mouse urodynamic function deriving from frequency-volume chart (FVC) measurements, voiding spot assays, filling cystometry, and pressure-flow studies. Similarly, an influence of the diurnal cycle on voiding is observed in mice and should be considered when interpreting rodent urodynamic studies, especially FVC measurements and voiding spot assays. Anaesthesia, restraint conditions, or filling rate influence mouse neuro-urodynamics. Mouse cystometric studies have observed intravesical pressure oscillations that accompany urine flow, attributed to high frequency opening and closing of the urethra. This characterization is not seen in other species, except rats. In contrast to human clinical urodynamics, the terminology of these examinations has not been standardized although many rodent urodynamic studies have been described. Conclusion: Mice have many anatomical and physiological similarities to humans and they are generally cost effective, and allow investigation of the effects of aging because of their short lifespan. There are some differences between mouse and human urodynamics. These must be considered when interpreting LUT function in mice, and translational value of murine disease models.
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Affiliation(s)
- Hiroki Ito
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Anthony E Pickering
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Yasuhiko Igawa
- Department of Continence Medicine, University of Tokyo Graduate School of Medicine Tokyo, Japan
| | - Anthony J Kanai
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Pennsylvania, PA, USA
| | - Christopher H Fry
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Marcus J Drake
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
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22
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Chapple CR, Siddiqui E. Mirabegron for the treatment of overactive bladder: a review of efficacy, safety and tolerability with a focus on male, elderly and antimuscarinic poor-responder populations, and patients with OAB in Asia. Expert Rev Clin Pharmacol 2017; 10:131-151. [DOI: 10.1080/17512433.2017.1275570] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Emad Siddiqui
- Global Medical Affairs, Astellas Pharma Europe Ltd, Chertsey, Surrey, UK
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23
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Drake MJ, Kanai A, Bijos DA, Ikeda Y, Zabbarova I, Vahabi B, Fry CH. The potential role of unregulated autonomous bladder micromotions in urinary storage and voiding dysfunction; overactive bladder and detrusor underactivity. BJU Int 2016; 119:22-29. [PMID: 27444952 DOI: 10.1111/bju.13598] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The isolated bladder shows autonomous micromotions, which increase with bladder distension, generate sensory nerve activity, and are altered in models of urinary dysfunction. Intravesical pressure resulting from autonomous activity putatively reflects three key variables; the extent of micromotion initiation, distances over which micromotions propagate, and overall bladder tone. In vivo, these variables are subordinate to the efferent drive of the central nervous system. In the micturition cycle storage phase, efferent inhibition keeps autonomous activity generally at a low level, where it may signal 'state of fullness', whilst maintaining compliance. In the voiding phase, mass efferent excitation elicits generalised contraction (global motility initiation). In lower urinary tract dysfunction, efferent control of the bladder can be impaired, for example due to peripheral 'patchy' denervation. In this case, loss of efferent inhibition may enable unregulated micromotility, and afferent stimulation, predisposing to urinary urgency. If denervation is relatively slight, the detrimental impact on voiding may be low, as the adjacent innervated areas may be able to initiate micromotility synchronous with the efferent nerve drive, so that even denervated areas can contribute to the voiding contraction. This would become increasingly inefficient the more severe the denervation, such that ability of triggered micromotility to propagate sufficiently to engage the denervated areas in voiding declines, so the voiding contraction increasingly develops the characteristics of underactivity. In summary, reduced peripheral coverage by the dual efferent innervation (inhibitory and excitatory) impairs regulation of micromotility initiation and propagation, potentially allowing emergence of overactive bladder and, with progression, detrusor underactivity.
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Affiliation(s)
- Marcus J Drake
- School of Clinical Sciences, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.,Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK
| | | | - Dominika A Bijos
- Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK
| | - Youko Ikeda
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bahareh Vahabi
- Bristol Urological Institute, Southmead Hospital, University of West of England, Bristol, UK.,School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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24
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Urothelial ATP exocytosis: regulation of bladder compliance in the urine storage phase. Sci Rep 2016; 6:29761. [PMID: 27412485 PMCID: PMC4944198 DOI: 10.1038/srep29761] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/24/2016] [Indexed: 12/30/2022] Open
Abstract
The bladder urothelium is more than just a barrier. When the bladder is distended, the urothelium functions as a sensor to initiate the voiding reflex, during which it releases ATP via multiple mechanisms. However, the mechanisms underlying this ATP release in response to the various stretch stimuli caused by bladder filling remain largely unknown. Therefore, the aim of this study was to elucidate these mechanisms. By comparing vesicular nucleotide transporter (VNUT)-deficient and wild-type male mice, we showed that ATP has a crucial role in urine storage through exocytosis via a VNUT-dependent mechanism. VNUT was abundantly expressed in the bladder urothelium, and when the urothelium was weakly stimulated (i.e. in the early filling stages), it released ATP by exocytosis. VNUT-deficient mice showed reduced bladder compliance from the early storage phase and displayed frequent urination in inappropriate places without a change in voiding function. We conclude that urothelial, VNUT-dependent ATP exocytosis is involved in urine storage mechanisms that promote the relaxation of the bladder during the early stages of filling.
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25
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Persyn S, De Wachter S, Wyndaele JJ, Eastham J, Gillespie J. The actions of isoprenaline and mirabegron in the isolated whole rat and guinea pig bladder. Auton Neurosci 2016; 198:19-27. [DOI: 10.1016/j.autneu.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 12/29/2022]
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Chien C, Wu HY. Young rats exhibit an age- and sex-dependent bladder response to alpha-antagonists but not beta-agonists. J Pediatr Urol 2016; 12:92.e1-8. [PMID: 26897326 DOI: 10.1016/j.jpurol.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Previous studies have suggested that the onset of alpha- (α) and beta- (β) adrenergic receptor activity is delayed in young animals. The use of alpha1- (α1-) antagonists for dysfunctional voiding, and beta3- (β3-) agonists for overactive bladder in younger children may not be indicated if maturation is required before bladder and urethral adrenergic receptors are active. OBJECTIVE To determine the sex- and age-dependent responses of the bladder and external urethral sphincter (EUS) to α- and β-adrenergic agents in neonatal and young adult rats. MATERIALS AND METHODS A total of 72 naïve Sprague-Dawley rats (36 female, 36 male) and 15 bladder-reduced (BR) female Sprague-Dawley rats underwent cystometry and EUS electromyography at 3, 6, and 9 weeks of life. Following administration of WAY 100,635 (0.3 mg/kg, serotonergic receptor antagonist), the non-selective α-agonist phenylephrine (0.3 mg/kg), α-antagonist phentolamine (1-3 mg/kg), β-agonist isoprenaline (3 mg/kg) and β-antagonist propranolol (3 mg/kg) were delivered intravenously. The maximum intravesical pressure (IVP), pressure threshold (PT), intermicturition interval (IMI), contraction duration (CD), burst amplitude and burst frequency were compared after each drug. RESULTS The α-antagonist phentolamine lowered the IVP in 9-week-old males without lowering the PT. In contrast, the β-agonist isoprenaline lowered the IVP in both males and females of all ages, also without affecting the PT. Isoprenaline was also effective at shortening the CD in females, suggesting more effective bladder emptying. The α-agonist phenylephrine increased the IVP in 3-week-old and 6-week-old females and 3-week-old males, but this effect was blocked by pretreatment with phentolamine. The β-antagonist propranolol increased the PT in both males and females, and shortened the IMI in females, which was consistent with retention. Phenylephrine increased the burst duration in 9-week-old naïve females, while isoprenaline increased the burst amplitude and duration in 9-week-old BR females. CONCLUSIONS In the neonatal rat, both α- and β-adrenergic receptors actively regulate bladder function by 3 weeks of life, but the desired effect of decreasing IVP by α-antagonists was delayed until 9 weeks in male rats. In contrast, β-agonists were effective at decreasing IVP in both male and female rats of all ages, which suggests that they are better agents for enhancing bladder emptying in female and young male rats.
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Affiliation(s)
- China Chien
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hsi-Yang Wu
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
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Monjotin N, Farrié M, Vergnolle N, Le Grand B, Gillespie J, Junquero D. Bladder telemetry: A new approach to evaluate micturition behavior under physiological and inflammatory conditions. Neurourol Urodyn 2016; 36:308-315. [PMID: 26879122 DOI: 10.1002/nau.22970] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/25/2016] [Indexed: 12/16/2022]
Abstract
AIMS To establish a new approach to cystometry using telemetry in conscious rats and to use this technique to determine the role of conscious decision making processes with respect to the initiation of voiding in physiological, inflammatory, and painful conditions. METHODS The pressure transducer of a telemetric transmitter was implanted in the dome of the urinary bladder. After a recovery period of at least 1 month, several investigations of urodynamic parameters were performed after diuresis activation by a pulse of furosemide. The model was characterized by tolterodine and mirabegron under physiological conditions and same animals were reused to evaluate the modification of the voiding pattern under bladder inflammation induced by cyclophosphamide. RESULTS The quality of traces and measurement of parameters recorded telemetrically were comparable to those with conventional cystometry. Furosemide induced a reproducible transient increase of urine production and a series of voids that persisted for 60 min. Tolterodine reduced the amplitude of micturition contractions although mirabegron was devoid of any effect. Seven hours after injection of CYP, voiding frequency increased significantly and the micturition amplitude contraction was not altered. However, the mean volume voided during individual micturitions and the total voided volume decreased. During a second exposure to furosemide 24H after CYP injection, the micturition pattern returned to control, however, the micturition volume was still lower than in control. CONCLUSION This telemetric model appears to be as accurate as previously described in conscious conventional cystometry, and allows the repeated evaluation of compounds which may modulate the voiding patterns. Neurourol. Urodynam. 36:308-315, 2017. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.
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Michel MC, Korstanje C. β3-Adrenoceptor agonists for overactive bladder syndrome: Role of translational pharmacology in a repositioning clinical drug development project. Pharmacol Ther 2016; 159:66-82. [PMID: 26808167 DOI: 10.1016/j.pharmthera.2016.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
β3-Adrenoceptor agonists were originally considered as a promising drug class for the treatment of obesity and/or type 2 diabetes. When these development efforts failed, they were repositioned for the treatment of the overactive bladder syndrome. Based on the example of the β3-adrenoceptor agonist mirabegron, but also taking into consideration evidence obtained with ritobegron and solabegron, we discuss challenges facing a translational pharmacology program accompanying clinical drug development for a first-in-class molecule. Challenges included generic ones such as ligand selectivity, species differences and drug target gene polymorphisms. Challenges that are more specific included changing concepts of the underlying pathophysiology of the target condition while clinical development was under way; moreover, a paucity of public domain tools for the study of the drug target and aspects of receptor agonists as drugs had to be addressed. Nonetheless, a successful first-in-class launch was accomplished. Looking back at this translational pharmacology program, we conclude that a specifically tailored and highly flexible approach is required. However, several of the lessons learned may also be applicable to translational pharmacology programs in other indications.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany.
| | - Cees Korstanje
- Department of Drug Discovery Science & Management-Europe, Astellas Pharma Europe R&D, Leiden, The Netherlands
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Edmondson SD, Zhu C, Kar NF, Di Salvo J, Nagabukuro H, Sacre-Salem B, Dingley K, Berger R, Goble SD, Morriello G, Harper B, Moyes CR, Shen DM, Wang L, Ball R, Fitzmaurice A, Frenkl T, Gichuru LN, Ha S, Hurley AL, Jochnowitz N, Levorse D, Mistry S, Miller RR, Ormes J, Salituro GM, Sanfiz A, Stevenson AS, Villa K, Zamlynny B, Green S, Struthers M, Weber AE. Discovery of Vibegron: A Potent and Selective β3 Adrenergic Receptor Agonist for the Treatment of Overactive Bladder. J Med Chem 2016; 59:609-23. [DOI: 10.1021/acs.jmedchem.5b01372] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Scott D. Edmondson
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Cheng Zhu
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Nam Fung Kar
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Jerry Di Salvo
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Hiroshi Nagabukuro
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Beatrice Sacre-Salem
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Karen Dingley
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Richard Berger
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Stephen D. Goble
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Gregori Morriello
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Bart Harper
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Christopher R. Moyes
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Dong-Ming Shen
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Liping Wang
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Richard Ball
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Aileen Fitzmaurice
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Tara Frenkl
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Loise N. Gichuru
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Sookhee Ha
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Amanda L. Hurley
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Nina Jochnowitz
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Dorothy Levorse
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Shruty Mistry
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Randy R. Miller
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - James Ormes
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Gino M. Salituro
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Anthony Sanfiz
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Andra S. Stevenson
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Katherine Villa
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Beata Zamlynny
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Stuart Green
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Mary Struthers
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
| | - Ann E. Weber
- Merck Research Laboratories, 2015 Galloping Hill Road, PO Box
539, Kenilworth, New Jersey 07033, United States
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Abstract
Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.
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Affiliation(s)
- Karen M Wallace
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Vij M, Drake MJ. Clinical use of the β3 adrenoceptor agonist mirabegron in patients with overactive bladder syndrome. Ther Adv Urol 2015; 7:241-8. [PMID: 26425139 DOI: 10.1177/1756287215591763] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mirabegron is a β3 adrenoceptor agonist licensed for the treatment of overactive bladder symptoms, such as urinary urgency or urgency incontinence. β3 adrenoceptor activation causes detrusor muscle relaxation, but mirabegron may also act by binding other targets in the bladder, and it may also reduce activity in sensory nerves. Phase III clinical trials (SCORPIO, ARIES, and CAPRICORN) evaluated mirabegron at various doses, demonstrating reduction from baseline to endpoint in mean incontinence episodes and mean number of micturitions per 24 h (coprimary endpoints), along with health-related quality of life and a range of secondary measures. Efficacy was seen in many patients who had previously discontinued antimuscarinic therapy on the grounds of lack of efficacy or poor tolerability. Treatment emergent adverse effects were documented in a long-term study (TAURUS), mostly being of mild or moderate severity. The most frequent adverse effects were hypertension, dry mouth, constipation, and headache, with a lower incidence of dry mouth than for the antimuscarinic active comparator. Efficacy and safety are not substantially different in older patients. A urodynamic safety study in men showed no consistent effect on voiding function, but a small increase in postvoid residual. Use of mirabegron in combination with α-adrenergic blockers does not appear to increase adverse effects. Dose reduction is needed in people with severe renal failure, or moderate hepatic failure. Dose adjustment is not needed in relation to food intake. Ongoing research is evaluating the potential for combination therapy with antimuscarinics.
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Affiliation(s)
| | - Marcus J Drake
- University of Bristol, Southmead Hospital, Bristol BS9 1BQ, UK
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Granato C, Korstanje C, Guilloteau V, Rouget C, Palea S, Gillespie JI. Prostaglandin E2 excitatory effects on rat urinary bladder: a comparison between the β-adrenoceptor modulation of non-voiding activity in vivo and micro-contractile activity in vitro. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:727-35. [DOI: 10.1007/s00210-015-1139-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/25/2015] [Indexed: 12/18/2022]
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Gillespie J.I, Rouget C, Palea S, Granato C, Korstanje C. Beta adrenergic modulation of spontaneous microcontractions and electrical field-stimulated contractions in isolated strips of rat urinary bladder from normal animals and animals with partial bladder outflow obstruction. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:719-26. [DOI: 10.1007/s00210-015-1136-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 05/20/2015] [Indexed: 01/20/2023]
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Stone E, Coote JH, Lovick TA. Effect of electrical vs. chemical deep brain stimulation at midbrain sites on micturition in anaesthetized rats. Acta Physiol (Oxf) 2015; 214:135-45. [PMID: 25778550 DOI: 10.1111/apha.12491] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/16/2015] [Accepted: 03/13/2015] [Indexed: 12/15/2022]
Abstract
AIM To understand how deep brain stimulation of the midbrain influences control of the urinary bladder. METHODS In urethane-anaesthetized male rats, saline was infused continuously into the bladder to evoke cycles of filling and voiding. The effect of electrical (0.1-2.0 ms pulses, 5-180 Hz, 0.5-2.5 V) compared to chemical stimulation (microinjection of D,L-homocysteic acid, 50 nL 0.1 M solution) at the same midbrain sites was tested. RESULTS Electrical stimulation of the periaqueductal grey matter and surrounding midbrain disrupted normal coordinated voiding activity in detrusor and sphincters muscles and suppressed urine output. The effect occurred within seconds was reversible and not secondary to cardiorespiratory changes. Bladder compliance remained unchanged. Chemical stimulation over the same area using microinjection of D,L-homocysteic acid (DLH) to preferentially activate somatodendritic receptors decreased the frequency of micturition but did not disrupt the coordinated pattern of voiding. In contrast, chemical stimulation within the caudal ventrolateral periaqueductal grey, in the area where critical synapses in the micturition reflex pathway are located, increased the frequency of micturition. CONCLUSION Electrical deep brain stimulation within the midbrain can inhibit reflex micturition. We suggest that the applied stimulus entrained activity in the neural circuitry locally, thereby imposing an unphysiological pattern of activity. In a way similar to the use of electrical signals to 'jam' radio transmission, this may prevent a synchronized pattern of efferent activity being transmitted to the spinal outflows to orchestrate a coordinated voiding response. Further experiments to record neuronal firing in the midbrain during the deep brain stimulation will be necessary to test this hypothesis.
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Affiliation(s)
- E. Stone
- School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
| | - J. H. Coote
- School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
| | - T. A. Lovick
- School of Physiology and Pharmacology; University of Bristol; Bristol UK
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The expression of β3-adrenoceptor and muscarinic type 3 receptor immuno-reactivity in the major pelvic ganglion of the rat. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:695-708. [DOI: 10.1007/s00210-015-1122-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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Vahabi B, Drake MJ. Physiological and pathophysiological implications of micromotion activity in urinary bladder function. Acta Physiol (Oxf) 2015; 213:360-70. [PMID: 25154454 DOI: 10.1111/apha.12373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/02/2014] [Accepted: 08/19/2014] [Indexed: 12/19/2022]
Abstract
'Micromotions' is a term signifying the presence of localized microcontractions and microelongations, alongside non-motile areas. The motile areas tend to shift over the bladder surface with time, and the intravesical pressure reflects moment-by-moment summation of the interplay between net contractile force generated by micromotions and general bladder tone. Functionally, the bladder structure may comprise modules with variable linkage, which supports presence of localized micromotions (no functional linkage between modules), propagating contractions (where emergence of linkage allows sequential activation) and the shifting of micromotions over time. Detrusor muscle, interstitial cells and intramural innervation have properties potentially relevant for initiating, coordinating and modulating micromotions. Conceptually, such activity could facilitate the generation of afferent activity (filling state reporting) in the absence of intravesical pressure change and the ability to transition to voiding at any bladder volume. This autonomous activity is an intrinsic property, seen in various experimental contexts including the clinical setting of human (female) overactive bladder. 'Disinhibited autonomy' may explain the obvious micromotions in isolated bladders and perhaps contribute clinically in neurological disease causing detrusor overactivity. Furthermore, any process that could increase the initiation or propagation of microcontractions might be anticipated to have a functional effect, increasing the likelihood of urinary urgency and detrusor overactivity respectively. Thus, models of bladder outlet obstruction, neurological trauma and ageing provide a useful framework for detecting cellular changes in smooth muscle, interstitial cells and innervation, and the consequent effects on micromotions.
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Affiliation(s)
- B. Vahabi
- Bristol Urological Institute; North Bristol NHS Trust; Bristol UK
- Department of Biological; Biomedical and Analytical Sciences; University of the West of England; Bristol UK
- School of Clinical Sciences; University of Bristol; Bristol UK
| | - M. J. Drake
- Bristol Urological Institute; North Bristol NHS Trust; Bristol UK
- School of Clinical Sciences; University of Bristol; Bristol UK
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Rouget C, Rekik M, Camparo P, Botto H, Rischmann P, Lluel P, Palea S, Westfall TD. Modulation of nerve-evoked contractions by β3-adrenoceptor agonism in human and rat isolated urinary bladder. Pharmacol Res 2013; 80:14-20. [PMID: 24378642 DOI: 10.1016/j.phrs.2013.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/12/2013] [Accepted: 12/18/2013] [Indexed: 12/18/2022]
Abstract
Activation of β3-adrenoceptors has been shown to have a direct relaxant effect on urinary bladder smooth muscle from both rats and humans, however there are very few studies investigating the effects of β3-adrenoceptor agonists on nerve-evoked bladder contractions. Therefore in the current study, the role of β3-adrenoceptors in modulating efferent neurotransmission was evaluated. The effects of β3-adrenoceptor agonism on neurogenic contractions induced by electrical field stimulation (EFS) were compared with effects on contractions induced by exogenous acetylcholine (Ach) and αβ-methylene adenosine triphosphate (αβ-meATP) in order to determine the site of action. Isoproterenol inhibited EFS-induced neurogenic contractions of human bladder (pD2=6.79; Emax=65%). The effect of isoproterenol was selectively inhibited by the β3-adrenoceptor antagonist L-748,337 (pKB=7.34). Contractions induced by exogenous Ach (0.5-1μM) were inhibited 25% by isoproterenol (3μM) while contractions to 10Hz in the same strip were inhibited 67%. The selective β3-adrenoceptor agonist CL-316,243 inhibited EFS-induced neurogenic contractions of rat bladder (pD2=7.83; Emax=65%). The effects of CL-316,243 were inhibited in a concentration dependent manner by L-748,337 (pA2=6.42). Contractions induced by exogenous Ach and αβ-meATP were significantly inhibited by CL-316,243, 29% and 40%, respectively. These results demonstrate that the activation of β3-adrenoceptors inhibits neurogenic contractions of both rat and human urinary bladder. Contractions induced by exogenously applied parasympathetic neurotransmitters are also inhibited by β3-agonism however the effect is clearly less than on neurogenic contractions (particularly in human), suggesting that in addition to a direct effect on smooth muscle, activation of prejunctional β3-adrenoceptors may inhibit neurotransmitter release.
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Affiliation(s)
- Céline Rouget
- UROsphere, Faculté des Sciences Pharmaceutiques, 35 chemin des Maraîchers, 31062 Toulouse Cedex 09, France
| | - Moèz Rekik
- UROsphere, Faculté des Sciences Pharmaceutiques, 35 chemin des Maraîchers, 31062 Toulouse Cedex 09, France
| | - Philippe Camparo
- Foch Hospital, Anatomy and Cytopathology Department, 92151 Suresnes Cedex, France
| | - Henry Botto
- Foch Hospital, Urology Department, 92151 Suresnes Cedex, France
| | - Pascal Rischmann
- Rangueil Hospital, Urology Department, 31059 Toulouse Cedex 9, France
| | - Philippe Lluel
- UROsphere, Faculté des Sciences Pharmaceutiques, 35 chemin des Maraîchers, 31062 Toulouse Cedex 09, France
| | - Stefano Palea
- UROsphere, Faculté des Sciences Pharmaceutiques, 35 chemin des Maraîchers, 31062 Toulouse Cedex 09, France
| | - Timothy D Westfall
- UROsphere, Faculté des Sciences Pharmaceutiques, 35 chemin des Maraîchers, 31062 Toulouse Cedex 09, France.
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