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Tsumori T, Tsumiyama W. Birth trauma simulated by vaginal distention induced possible irreversible changes in the composition of the fiber types in the external urethral sphincter of rats. Anat Rec (Hoboken) 2024; 307:385-394. [PMID: 37184304 DOI: 10.1002/ar.25242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
The external urethral sphincter (EUS) is crucial in urinary continence development. Understanding the morphological features of the EUS in female rats after vaginal distention (VD), using a model of birth trauma, would aid in evaluating its functional and metabolic properties. Our recent study demonstrated that the EUS in female rats expresses one slow (type 1) and two fast (types 2A and 2B) myosin heavy chain (MHC) isoforms. Our preliminary experiment revealed that type 2B isoform expression was markedly reduced in the EUS 4 weeks after VD. Here, we aimed to examine the expression patterns of these three types of MHC isoforms, and an embryonic MHC, a marker of regeneration fibers, in the EUS of rats 3 days and 1, 2, and 8 weeks after VD using immunofluorescence staining. Hence, type 2B fibers were selectively damaged early in post-VD and did not recover fully later. Muscle regeneration in the sphincter peaked 1 week after trauma using a marker of immature fibers, embryonic myosin heavy chain. Electron microscopy revealed that the EUS of female rats was composed of mitochondria-rich muscle fibers. Myoblasts or immature muscle fibers were discovered in the sphincter layer 1 week after trauma. These results suggest that myogenesis after VD may not contribute to restoring normal fiber composition in a female rat's EUS.
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Affiliation(s)
- Toshiko Tsumori
- Departments of Nursing, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Wakako Tsumiyama
- Departments of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
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2
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Shan S, Li Q, Criswell T, Atala A, Zhang Y. Stem cell therapy combined with controlled release of growth factors for the treatment of sphincter dysfunction. Cell Biosci 2023; 13:56. [PMID: 36927578 PMCID: PMC10018873 DOI: 10.1186/s13578-023-01009-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Sphincter dysfunction often occurs at the end of tubule organs such as the urethra, anus, or gastroesophageal sphincters. It is the primary consequence of neuromuscular impairment caused by trauma, inflammation, and aging. Despite intensive efforts to recover sphincter function, pharmacological treatments have not achieved significant improvement. Cell- or growth factor-based therapy is a promising approach for neuromuscular regeneration and the recovery of sphincter function. However, a decrease in cell retention and viability, or the short half-life and rapid degradation of growth factors after implantation, remain obstacles to the translation of these therapies to the clinic. Natural biomaterials provide unique tools for controlled growth factor delivery, which leads to better outcomes for sphincter function recovery in vivo when stem cells and growth factors are co-administrated, in comparison to the delivery of single therapies. In this review, we discuss the role of stem cells combined with the controlled release of growth factors, the methods used for delivery, their potential therapeutic role in neuromuscular repair, and the outcomes of preclinical studies using combination therapy, with the hope of providing new therapeutic strategies to treat incontinence or sphincter dysfunction of the urethra, anus, or gastroesophageal tissues, respectively.
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Affiliation(s)
- Shengzhou Shan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Tracy Criswell
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
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3
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Kishimoto S, Ishizuka M, Inoue KI, Yamanishi T, Shimizu T, Kaga K, Aoki T, Kubota K. Local transplantation of syngeneic adipose stromal vascular fraction ameliorates damaged anal sphincter function in a rat model of vaginal distension. Surgery 2022; 172:1093-1101. [PMID: 35973873 DOI: 10.1016/j.surg.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The adipose stromal vascular fraction contains abundant mesenchymal stem cells and is utilized for cell therapy of male stress urinary incontinence. The purpose of this paper was to explore the effect of local transplantation of the stromal vascular fraction on improvement of damaged anal sphincter function. METHODS A rat model of vaginal distension was used as a model of damaged anal sphincter function. The adipose stromal vascular fraction was separated from the inguinal fat of syngeneic green fluorescent protein transgenic rats and delivered into the internal anal sphincter of vaginal distension rats. The maximum resting pressure was evaluated during insertion and withdrawal of the catheter at 4 or 10 days after vaginal distension treatment to estimate anal sphincter function. Green fluorescent protein-transfected human-adipose-derived mesenchymal stem cells were transplanted into the internal anal sphincter of nude rats. Hematoxylin-eosin and Masson trichrome staining were performed to evaluate tissue damage and collagen synthesis. Transplanted cells were identified using a green fluorescent protein antibody and a human-specific antibody. Activation of the transplanted human-ADSC was evaluated by quantitative RT-PCR RESULTS: The mean maximum resting pressure (during catheter withdrawal) of vaginal distension rats was significantly lower than that of control rats, and stromal vascular fraction injection normalized it 4 days after treatment (control: 5.66 ± 0.98, vaginal distension: 4.04 ± 1.28, vaginal distension + stromal vascular fraction: 5.92 ± 1.28 [mmHg, control versus vaginal distension: P = .039; vaginal distension versus vaginal distension + stromal vascular fraction: P = .007]). Histological examination showed that vaginal distension disrupted the internal anal sphincter, and the transplanted syngeneic stromal vascular fraction survived for 10 days. Transplanted xenogeneic human-adipose-derived mesenchymal stem cells survived in the internal anal sphincter of nude rats for 4 and 10 days. Genes related to extracellular remodeling were up-regulated in the transplanted human-adipose-derived mesenchymal stem cells CONCLUSION: Syngeneic and heterotopic transplanted adipose-derived mesenchymal stem cells engrafted in the internal anal sphincter and ameliorated damaged anal sphincter function in a rat model of vaginal distension.
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Affiliation(s)
- Satoko Kishimoto
- Comprehensive Research Facilities for Advanced Medical Science, Research Center for Advanced Medical Science, Dokkyo Medical University, Tochigi, Japan
| | - Mitsuru Ishizuka
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan; Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Ken-Ichi Inoue
- Comprehensive Research Facilities for Advanced Medical Science, Research Center for Advanced Medical Science, Dokkyo Medical University, Tochigi, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shimizu
- Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kanya Kaga
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Taku Aoki
- Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan
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De La Torre P, Pérez-Lorenzo MJ, Alcázar-Garrido Á, Collado J, Martínez-López M, Forcén L, Masero-Casasola AR, García A, Gutiérrez-Vélez MC, Medina-Polo J, Muñoz E, Flores AI. Perinatal mesenchymal stromal cells of the human decidua restore continence in rats with stress urinary incontinence induced by simulated birth trauma and regulate senescence of fibroblasts from women with stress urinary incontinence. Front Cell Dev Biol 2022; 10:1033080. [PMID: 36742196 PMCID: PMC9893794 DOI: 10.3389/fcell.2022.1033080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Stress urinary incontinence (SUI) is a condition that causes the involuntary loss of urine when making small efforts, which seriously affects daily life of people who suffer from it. Women are more affected by this form of incontinence than men, since parity is the main risk factor. Weakening of the pelvic floor tissues is the cause of SUI, although a complete understanding of the cellular and molecular mechanisms of the pathology is still lacking. Reconstructive surgery to strengthen tissue in SUI patients is often associated with complications and/or is ineffective. Mesenchymal stromal cells from the maternal side of the placenta, i.e. the decidua, are proposed here as a therapeutic alternative based on the regenerative potential of mesenchymal cells. The animal model of SUI due to vaginal distention simulating labor has been used, and decidual mesenchymal stromal cell (DMSC) transplantation was effective in preventing a drop in pressure at the leak point in treated animals. Histological analysis of the urethras from DMSC-treated animals after VD showed recovery of the muscle fiber integrity, low or no extracellular matrix (ECM) infiltration and larger elastic fibers near the external urethral sphincter, compared to control animals. Cells isolated from the suburethral connective tissue of SUI patients were characterized as myofibroblasts, based on the expression of several specific genes and proteins, and were shown to achieve premature replicative senescence. Co-culture of SUI myofibroblasts with DMSC via transwell revealed a paracrine interaction between the cells through signals that mediated DMSC migration, SUI myofibroblast proliferation, and modulation of the proinflammatory and ECM-degrading milieu that is characteristic of senescence. In conclusion, DMSC could be an alternative therapeutic option for SUI by counteracting the effects of senescence in damaged pelvic tissue.
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Affiliation(s)
- Paz De La Torre
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Álvaro Alcázar-Garrido
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Jennifer Collado
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Laura Forcén
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana R. Masero-Casasola
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alicia García
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mª Carmen Gutiérrez-Vélez
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Medina-Polo
- Male’s Integral Health Group, Urology Department, Research Institute Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eloy Muñoz
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana I. Flores
- Regenerative Medicine Group, Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- *Correspondence: Ana I. Flores,
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Feitosa SM, Bortolini MAT, Salerno GRF, Bilhar APM, Ihara SSM, Simões MJ, Castro RA. Electrotherapy for urethral modulation: Are extracellular matrix molecules and growth factors potential targets? Neurourol Urodyn 2021; 40:968-977. [PMID: 33769595 DOI: 10.1002/nau.24664] [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: 06/22/2020] [Revised: 02/01/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate the expression of genes and proteins involved in the urethral components: vessels, nerves, and extracellular matrix, in female rats after trauma by vaginal distension (VD) and after electrical stimulation therapy (electrotherapy). METHODS We analyzed the urethras of three groups of 18 female rats 30 days posttrauma by VD: control (no interventions); trauma (animals that had VD); and electrotherapy group (those that had VD and were treated with electrical stimulation). We compared the expression of vascular endothelial growth factor (VEGF), nerve growth factor (NGF), collagen types I and III (COL1a1 and COL3a1), and lysyl-oxidase like 1 (LOXL1) among the groups. Real-time reverse transcription-polymerase chain reaction, Western blot, and immunohistochemistry were used for molecule quantification. We used the Kruskal-Wallis test and analysis of variance for statistical analyses with p < 0.05 for significance. RESULTS The COL1a1 gene expression was higher in the electrotherapy group than the trauma group (p = 0.036). COL3a1, VEGF, NGF, LOXL1 messenger RNA (mRNA) expression did not differ among the groups (p ≥ 0.05). COL1a1, COL3a1, VEGF, NGF, LOXL1 protein levels did not significantly differ among the groups (p ≥ 0.05) in Western blot analysis or immunohistochemistry assays. CONCLUSIONS Electrotherapy caused a long-term increase in the COL1a1 mRNA level but did not change COL1a1 protein expression or VEGF, NGF, COL3a1, and LOXL1 genes and proteins in the urethras of rats after trauma by VD.
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Affiliation(s)
- Suellen M Feitosa
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria A T Bortolini
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gisela R F Salerno
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andreisa P M Bilhar
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal do Ceará, Ceará, Brazil
| | - Silvia S M Ihara
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manuel J Simões
- Department of Histology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Castro
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
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El Hassan R, Galante A, Kavran M, Ganocy S, Khalifa AO, Hijaz A. The vaginal distention model in mice is not a reliable model of simulated birth trauma-induced stress urinary incontinence. Neurourol Urodyn 2018; 38:599-606. [PMID: 30549310 DOI: 10.1002/nau.23886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022]
Abstract
AIMS Vaginal distention (VD) is a validated model of birth-related trauma in rats. Recently a mouse VD model was reported. Our study was originally conducted to evaluate the impact of age on VD in mice. This manuscript describes the study and reports on the lack of reproducibility of VD models in mice. METHODS We utilized female C57BL/6 mice. A total of 190, 12-weeks old mice, were randomized into VD and sham groups. We inflated a modified Foley's balloon with 0.3 mL for 1 h inside the mice vagina. Afterwards, we measured the leak point pressure (LPP) at defined timepoints (0, 4, 10, 20, or 40 days). We randomized another 190, 40-week old, C57BL/6 mice into either VD or sham groups. We used an extra 20 mice as age - matched controls. RESULTS In both 12 and 40 weeks-old mice, LPP was significantly decreased versus the negative controls at day 0. Additionally, in both 12 and 40 weeks-old mice, the decrease in LPP was significantly higher in the VD group compared to the sham group at day 0. However, the LPP results were comparable between VD and sham at any other time point thereafter. Furthermore, there was no significant change in LPP values between instrumented (VD and sham) mice and control mice at any time after day 0. CONCLUSIONS The VD models previously described is not a reproducible model for the study of VD with large number of mice. Our results, unfortunately, do not support its use to study VD injury in mice.
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Affiliation(s)
- Ramzi El Hassan
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Alex Galante
- Department of Urology, University of Florida, Gainesville, Florida
| | - Michael Kavran
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Stephen Ganocy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University,, Cleveland, Ohio
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.,Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Adonis Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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7
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Catanzarite T, Bremner S, Barlow CL, Bou-Malham L, O'Connor S, Alperin M. Pelvic muscles' mechanical response to strains in the absence and presence of pregnancy-induced adaptations in a rat model. Am J Obstet Gynecol 2018; 218:512.e1-512.e9. [PMID: 29432755 DOI: 10.1016/j.ajog.2018.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/09/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maternal birth trauma to the pelvic floor muscles is thought to be consequent to mechanical demands placed on these muscles during fetal delivery that exceed muscle physiological limits. The above is consistent with studies of striated limb muscles that identify hyperelongation of sarcomeres, the functional muscle units, as the primary cause of mechanical muscle injury and resultant muscle dysfunction. However, pelvic floor muscles' mechanical response to strains have not been examined at a tissue level. Furthermore, we have previously demonstrated that during pregnancy, rat pelvic floor muscles acquire structural and functional adaptations in preparation for delivery, which likely protect against mechanical muscle injury by attenuating the strain effect. OBJECTIVE We sought to determine the mechanical impact of parturition-related strains on pelvic floor muscles' microstructure, and test the hypothesis that pregnancy-induced adaptations modulate muscle response to strains associated with vaginal delivery. STUDY DESIGN Three-month-old Sprague-Dawley late-pregnant (N = 20) and nonpregnant (N = 22) rats underwent vaginal distention, replicating fetal crowning, with variable distention volumes. Age-matched uninjured pregnant and nonpregnant rats served as respective controls. After sacrifice, pelvic floor muscles, which include coccygeus, iliocaudalis, and pubocaudalis, were fixed in situ and harvested for fiber and sarcomere length measurements. To ascertain the extent of physiological strains during spontaneous vaginal delivery, analogous measurements were obtained in intrapartum rats (N = 4) sacrificed during fetal delivery. Data were compared with repeated measures and 2-way analysis of variance, followed by pairwise comparisons, with significance set at P < .05. RESULTS Gross anatomic changes were observed in the pelvic floor muscles following vaginal distention, particularly in the entheseal region of pubocaudalis, which appeared translucent. The above appearance resulted from dramatic stretch of the myofibers, as indicated by significantly longer fiber length compared to controls. Stretch ratios, calculated as fiber length after vaginal distention divided by baseline fiber length, increased gradually with increasing distention volume. Paralleling these macroscopic changes, vaginal distention resulted in acute and progressive increase in sarcomere length with rising distention volume. The magnitude of strain effect varied by muscle, with the greatest sarcomere elongation observed in coccygeus, followed by pubocaudalis, and a smaller increase in iliocaudalis, observed only at higher distention volumes. The average fetal rat volume approximated 3 mL. Pelvic floor muscle sarcomere lengths in pregnant animals undergoing vaginal distention with 3 mL were similar to intrapartum sarcomere lengths in all muscles (P > .4), supporting the validity of our experimental approach. Vaginal distention resulted in dramatically longer sarcomere lengths in nonpregnant compared to pregnant animals, especially in coccygeus and pubocaudalis (P < .0001), indicating significant attenuation of sarcomere elongation in the presence of pregnancy-induced adaptations in pelvic floor muscles. CONCLUSION Delivery-related strains lead to acute sarcomere elongation, a well-established cause of mechanical injury in skeletal muscles. Sarcomere hyperelongation resultant from mechanical strains is attenuated by pregnancy-induced adaptations acquired by the pelvic floor muscles prior to parturition.
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Affiliation(s)
- Tatiana Catanzarite
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shannon Bremner
- Department of Orthopedic Surgery, University of California-San Diego, San Diego, CA
| | - Caitlin L Barlow
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Laura Bou-Malham
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shawn O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - Marianna Alperin
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA.
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8
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Bortolini MAT, Feitosa SM, Bilhar APM, Salerno GGR, Zanoteli E, Simões MJ, Castro RA. Molecular and histomorphological evaluation of female rats’ urethral tissues after an innovative trauma model of prolonged vaginal distention: immediate, short-term and long-term effects. Int Urogynecol J 2018; 30:465-476. [DOI: 10.1007/s00192-018-3634-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/08/2018] [Indexed: 02/06/2023]
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9
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Inoue KI, Kishimoto S, Kaga K, Fuse M, Furuta A, Yamanishi T. Autologous and heterotopic transplantation of adipose stromal vascular fraction ameliorates stress urinary incontinence in rats with simulated childbirth trauma. Regen Ther 2017; 8:9-14. [PMID: 30271860 PMCID: PMC6147152 DOI: 10.1016/j.reth.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/10/2017] [Accepted: 11/29/2017] [Indexed: 01/30/2023] Open
Abstract
Introduction Autologous transplantation of adipose stromal vascular fraction (SVF) is a cost-effective and technically accessible option for cell therapy. Clinical study of SVF transplantation for male stress urinary incontinence (SUI) is underway, but the effectiveness remains unknown for female SUI, majority of which is caused by childbirth trauma. Methods Vaginal Distension (VD) rats were generated as in vivo model for female SUI. To quantitate the severity of SUI, leak point pressure (LPP) was measured by placing a bladder catheter. There was a characteristic waveform of LPP with two-peaks, and we counted the second peak as an LPP value. Adipose SVF was separated from inguinal fat and delivered into external urethral sphincter (EUS) through transperineal injection. LPP was measured 7 or 14 days after SVF transplantation. Tissue damage and collagen synthesis around the EUS were visualized by Masson's trichrome and eosin staining. Antibody against α-smooth muscle actin (α-SMA) was used to stain smooth muscle or activated stromal cells. Donor SVF cells were distinguished from recipient EUS tissue by tracking with GFP transgene. Results VD procedure decreased the frequency at which the normal LPP waveform appeared and lowered the LPP value. SVF injection normalized the waveform as well as the level of LPP. VD disrupted histological structure of EUS and SVF failed to differentiate into striatal muscles. Instead, SVF increased α-SMA positive cells and collagen synthesis but the phenomena depended on VD stimulus. GFP tracking indicated that the transplanted SVF cells persisted for four weeks and synthesized α-SMA protein simultaneously. Conclusions Autologous transplantation of adipose SVF displayed bulking effects through collagen synthesis. However, such heterotopic activation was dependent on tissue damage. VD rat is a reproducible in vivo model for female SUI. LPP waveform is a good indicator of normal EUS function. Transplantation of adipose SVF normalizes LPP decline caused by VD. Heterotopic SVF synthesizes collagen, depending on tissue damage. Heterotopic SVF does not display voiding obstruction.
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Affiliation(s)
- Ken-Ichi Inoue
- Center for Research Support, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Satoko Kishimoto
- Center for Research Support, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kanya Kaga
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Miki Fuse
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Akira Furuta
- Department of Urology, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-0003, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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10
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Yan H, Zhong L, Jiang Y, Yang J, Deng J, Wei S, Opara E, Atala A, Mao X, Damaser MS, Zhang Y. Controlled release of insulin-like growth factor 1 enhances urethral sphincter function and histological structure in the treatment of female stress urinary incontinence in a rat model. BJU Int 2017; 121:301-312. [PMID: 28805303 DOI: 10.1111/bju.13985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the effects of controlled release of insulin-like growth factor 1 (IGF-1) from alginate-poly-L-ornithine-gelatine (A-PLO-G) microbeads on external urethral sphincter (EUS) tissue regeneration in a rat model of stress urinary incontinence (SUI), as SUI diminishes the quality of life of millions, particularly women who have delivered vaginally, which can injure the urethral sphincter. Despite several well-established treatments for SUI, growth factor therapy might provide an alternative to promote urethral sphincter repair. MATERIALS AND METHODS In all, 44 female Sprague-Dawley rats were randomised into four groups: vaginal distension (VD) followed by periurethral injection of IGF-1-A-PLO-G microbeads (VD + IGF-1 microbeads; 1 × 104 microbeads/1 mL normal saline); VD + empty microbeads; VD + saline; or sham-VD + saline (sham). RESULTS Urethral function (leak-point pressure, LPP) was significantly lesser 1 week after VD + saline [mean (sem) 23.9 (1.3) cmH2 O] or VD + empty microbeads [mean (sem) 21.7 (0.8) cmH2 O) compared to the sham group [mean (sem) 44.4 (3.4) cmH2 O; P < 0.05), indicating that the microbeads themselves do not create a bulking or obstructive effect in the urethra. The LPP was significantly higher 1 week after VD + IGF-1 microbeads [mean (sem) 28.4 (1.2) cmH2 O] compared to VD + empty microbeads (P < 0.05), and was not significantly different from the LPP in sham rats, demonstrating an initiation of a reparative effect even at 1 week after VD. Histological analysis showed well-organised skeletal muscle fibres and vascular development in the EUS at 1 week after VD + IGF-1 microbeads, compared to substantial muscle fibre attenuation and disorganisation, and less vascular formation at 1 week after VD + saline or VD + empty microbeads. CONCLUSION Periurethral administration of IGF-1-A-PLO-G microbeads facilitates recovery from SUI by promoting skeletal myogenesis and revascularisation. This therapy is promising, but detailed and longer term studies in animal models and humans are needed.
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Affiliation(s)
- Hao Yan
- Biomedical Engineering Department of the Lerner Research Institute, Cleveland, OH, USA.,Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liren Zhong
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaodong Jiang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Yang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Junhong Deng
- Department of Andrology, The First People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Shicheng Wei
- Laboratory of Biomaterials and Regenerative Medicine, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Emmanuel Opara
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anthony Atala
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Xiangming Mao
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Margot S Damaser
- Biomedical Engineering Department of the Lerner Research Institute, Cleveland, OH, USA.,The Advanced Platform Technology Center of the Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
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11
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Callewaert G, Da Cunha MMCM, Sindhwani N, Sampaolesi M, Albersen M, Deprest J. Cell-based secondary prevention of childbirth-induced pelvic floor trauma. Nat Rev Urol 2017; 14:373-385. [PMID: 28374792 DOI: 10.1038/nrurol.2017.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With advancing population age, pelvic-floor dysfunction (PFD) will affect an increasing number of women. Many of these women wish to maintain active lifestyles, indicating an urgent need for effective strategies to treat or, preferably, prevent the occurrence of PFD. Childbirth and pregnancy have both long been recognized as crucial contributing factors in the pathophysiology of PFD. Vaginal delivery of a child is a serious traumatic event, causing anatomical and functional changes in the pelvic floor. Similar changes to those experienced during childbirth can be found in symptomatic women, often many years after delivery. Thus, women with such PFD symptoms might have incompletely recovered from the trauma caused by vaginal delivery. This hypothesis creates the possibility that preventive measures can be initiated around the time of delivery. Secondary prevention has been shown to be beneficial in patients with many other chronic conditions. The current general consensus is that clinicians should aim to minimize the extent of damage during delivery, and aim to optimize healing processes after delivery, therefore preventing later dysfunction. A substantial amount of research investigating the potential of stem-cell injections as a therapeutic strategy for achieving this purpose is currently ongoing. Data from small animal models have demonstrated positive effects of mesenchymal stem-cell injections on the healing process following simulated vaginal birth injury.
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Affiliation(s)
- Geertje Callewaert
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | | | - Nikhil Sindhwani
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maurilio Sampaolesi
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maarten Albersen
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Urology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
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12
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Palacios JL, Juárez M, Morán C, Xelhuantzi N, Damaser MS, Cruz Y. Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats. Am J Physiol Renal Physiol 2016; 310:F1065-73. [PMID: 26936873 PMCID: PMC6880194 DOI: 10.1152/ajprenal.00417.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/26/2016] [Indexed: 01/07/2023] Open
Abstract
The aim of the present study was to use a model of simulated human childbirth in rats to determine the damage to genitourinary structures and behavioral signs of urinary dysfunction induced by vaginal distension (VD) in female rats. In experiment 1, the length of the genitourinary tract and the nerves associated with it were measured immediately after simulated human delivery induced by VD or sham (SH) procedures. Electroneurograms of the dorsal nerve of the clitoris (DNC) were also recorded. In experiment 2, histological characteristics of the bladder and major pelvic ganglion of VD and SH rats were evaluated. In experiment 3, urinary parameters were determined in conscious animals during 6 h of dark and 6 h of light before and 3 days after VD or SH procedures. VD significantly increased distal vagina width (P < 0.001) and the length of the motor branch of the sacral plexus (P < 0.05), DNC (P < 0.05), and vesical nerves (P < 0.01) and decreased DNC frequency and amplitude of firing. VD occluded the pelvic urethra, inducing urinary retention, hematomas in the bladder, and thinness of the epithelial (P < 0.05) and detrusor (P < 0.01) layers of the bladder. Major pelvic ganglion parameters were not modified after VD. Rats dripped urine in unusual places to void, without the stereotyped behavior of micturition after VD. The neuroanatomic injuries after VD occur alongside behavioral signs of urinary incontinence as determined by a new behavioral tool for assessing micturition in conscious animals.
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Affiliation(s)
- J L Palacios
- Doctorado en Ciencias Biológicas, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - M Juárez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - C Morán
- Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - N Xelhuantzi
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - M S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; and Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Y Cruz
- Doctorado en Ciencias Biológicas, Universidad Autónoma de Tlaxcala, Tlaxcala, México; Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México;
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13
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Hakim L, De Ridder D, Van der Aa F. Slings for urinary incontinence and the application of cell-based therapy. Adv Drug Deliv Rev 2015; 82-83:22-30. [PMID: 25463774 DOI: 10.1016/j.addr.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 11/08/2014] [Indexed: 02/08/2023]
Abstract
The most commonly used technique for the treatment of stress urinary incontinence (SUI) in women is the suburethral polypropylene sling, using either a retropubic or transobturator tape approach This treatment results in a cure rate of over 80%, based on both subjective and objective evaluations. Biological slings have been largely abandoned due to lack of efficacy. Despite the high success rates, 10-20% of women remain incontinent. Cell-based therapy might offer solutions for the future both for the primary setting as for the treatment of failures. Preclinical studies suggest that stem cells (SC) can enhance the recovery of damaged tissue either by direct integration and replacement of damaged tissue (differentiation) or by secreting factors that influence host response mechanisms (paracrine effect). The clinical data to date do not allow strong efficacy conclusions, except that SC therapy seems to be safe in the short term. Most published studies use autologous cells. Allogeneic cell sources need to be investigated as well to allow ready-to-use solutions in the future. Most importantly, we need better insight into the mechanisms of action. We need more basic stem cell research, better acute and chronic animal models, better investigational tools and more efforts using tissue engineering approach.
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14
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Herrera-Imbroda B, Lara MF, Izeta A, Sievert KD, Hart ML. Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter. Adv Drug Deliv Rev 2015; 82-83:106-16. [PMID: 25453264 DOI: 10.1016/j.addr.2014.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 01/19/2023]
Abstract
Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI.
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15
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Successful induction of stress urinary incontinence in mice by vaginal distension does not depend on the estrous cycle. Urology 2014; 83:958.e1-6. [PMID: 24548710 DOI: 10.1016/j.urology.2013.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/12/2013] [Accepted: 12/16/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if the performance of vaginal distension (VD) in different estrous cycle phases affects the successful induction of stress urinary incontinence in mice. METHODS Female virgin C57BL/6 mice were distributed into 4 groups according to their estrous cycle phase: proestrus, estrus, metestrus, or diestrus. The estrous cycle was staged by examining vaginal smears, and the method was corroborated by histologic examination of the vagina in a subset of each group. Each group was divided into 4 subgroups for measurement of 24-hour micturition behavior and the leak point pressure (LPP) 4 or 20 days after VD or sham VD. RESULTS Voiding events increased and mean void volume decreased 4 days, but not 20 days after VD, and the LPP was decreased 4 days, but not 20 days after VD compared with the corresponding sham group, regardless of the estrous cycle phase when VD was performed. There were no differences in 24-hour micturition behavior or LPP among the 4 different estrous cycle phases either in sham or VD group. CONCLUSION Successful induction of reversible stress urinary incontinence in mice is not dependent on the estrous cycle.
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16
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Song QX, Balog BM, Kerns J, Lin DL, Sun Y, Damaser MS, Jiang HH. Long-term effects of simulated childbirth injury on function and innervation of the urethra. Neurourol Urodyn 2014; 34:381-6. [PMID: 24501018 DOI: 10.1002/nau.22561] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/19/2013] [Indexed: 11/09/2022]
Abstract
AIMS Pudendal nerve and external urethral sphincter (EUS) injury during vaginal delivery are risk factors for stress urinary incontinence (SUI). Although most patients with short-term postpartum SUI regain continence within 1 year, they have a higher predisposition to develop recurrent SUI years later, suggesting a possible mechanistic relationship. In contrast, animal models generally recover spontaneously and have not been studied much in the long term. The aim of this study was to investigate the long-term effects of simulated childbirth injury in rats. METHODS Thirty-four Sprague-Dawley female rats underwent sham injury or pudendal nerve crush and vaginal distension (PNC + VD), a simulated childbirth injury. Nine weeks later, leak point pressure (LPP) and EUS electromyography (EMG) were recorded simultaneously. The pudendal nerve was harvested for histological analysis. EUS neuromuscular junctions (NMJs) and their innervation were qualitatively assessed using immunofluorescence. A t-test was used to compare quantitative outcomes between groups, with P < 0.05 indicating a significant difference. RESULTS There was no significant difference in LPP or EUS EMG amplitude or firing rate between the two groups. Nonetheless after PNC + VD, NMJs in the EUS were diffuse and were innervated by tortuous and multiple axons, demonstrating that reinnervation of the EUS was still in progress. CONCLUSIONS Although continence function recovered 9 weeks after simulated childbirth injury, innervation of EUS was not complete at this time point, suggestive of persistent neurogenic deficiency which when compounded by the effects of aging may lead to a delayed recurrence of SUI in this animal model with increased age.
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Affiliation(s)
- Qi-Xiang Song
- Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, Ohio; Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China; Advanced Platform Technology Rehabilitation R&D Center of Excellence, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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17
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Hakim L, Endo M, Feola A, Soebadi DM, Deprest J, De Ridder D, Albersen M, Van der Aa F. High-frequency micro-ultrasound: a novel method to assess external urethral sphincter function in rats following simulated birth injury. Neurourol Urodyn 2014; 34:264-9. [PMID: 24436081 DOI: 10.1002/nau.22555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Abstract
AIMS We evaluated external urethral sphincter (EUS) function using high-frequency micro-ultrasound (US) in rats that were either uninjured (Control, C) or underwent vaginal distension (VD) as a substitute for vaginal birth injury induced stress urinary incontinence (SUI). METHODS Thirteen female nulliparous Sprague-Dawley rats of 12 weeks were divided into two groups, either C (n = 6) or VD (n = 7). Vaginal balloon distension was performed under pentobarbital anesthesia for 4 hours. Five days after the injury, all animals underwent US assessment of the urethra during high-rate bladder filling and urine leakage/voiding. Urinary leakage, the presence, absence, and pattern of EUS bursting during the voiding phase were registered, and pre-determined parameters of intercontraction interval (ICI), length of contraction (LOC), and rate of contraction (ROC) were registered. RESULTS Our ultrasound findings consistently showed the presence of rhythmic EUS bursting in all of the C rats (6/6), which were absent in all VD rats (0/7). The mean of ROC, ICI, and LOC in C group were 3.02 ± 0.12 contractions/sec, 471.43 ± 17.9 msec, and 103.41 ± 3.28 msec, respectively. CONCLUSIONS Pre-determined parameters of LOC, ICI, and ROC during US provide objective and measurable data on EUS function. US showed the total disappearance of EUS bursting in the VD group as compared to the C group. These results indicate that ultrasound testing may become a valuable non-invasive tool in future translational studies to investigate SUI/urethral function in rat models.
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Affiliation(s)
- Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, Airlangga University School of Medicine/Dr. Soetomo General Hospital, Surabaya, Indonesia
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18
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Hijaz AK, Grimberg KO, Tao M, Schmotzer B, Sadeghi Z, Lin YH, Kavran M, Ozer A, Xiao N, Daneshgari F. Stem cell homing factor, CCL7, expression in mouse models of stress urinary incontinence. Female Pelvic Med Reconstr Surg 2013; 19:356-61. [PMID: 24165450 DOI: 10.1097/spv.0b013e3182a331a9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Animal models of vaginal distention (VD) have demonstrated increased expression of chemokine (C-C motif) ligand 7 (CCL7) In this study, we investigated the expression of CCL7 in mice models of simulated birth trauma-induced urinary incontinence using VD and pudendal nerve transection (PNT). METHODS Forty-nine mice were divided into 6 groups: VD, sham VD, PNT, sham PNT, anesthesia, and age-matched controls. The urethra, vagina, and rectum were harvested for the expression of CCL7 immediately or 24 hours after assigned procedure. Venous sampling for quantification of serum CCL7 was also performed. An analysis of variance model was used to compare the relative expression of CCL7 in each group. RESULTS Urethral CCL7 expression in the VD group was significantly higher than control group after 24 hours (P < 0.01). There was no difference in the urethral CCL7 expression in PNT, sham PNT, sham VD, or anesthesia groups compared with the controls. No statistically significant difference was noted in the vaginal and rectal expression of CCL7 between any of the groups except for sham PNT. Statistically significant differences were noted in the serum CCL7 expression in the VD, PNT, and sham PNT (P < 0.01 in all) groups after 24 hours compared with the control group. CONCLUSIONS This study demonstrates overexpression of urethral CCL7 after VD but not PNT. This suggests that nerve injury does not contribute to the CCL7 overexpression. The overexpression of CCL7 in the serum of mice after VD suggests a translational potential where CCL7 measurement could be used as a surrogate for injury after delivery.
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Affiliation(s)
- Adonis K Hijaz
- From the *Department of Urology, Case Western Reserve University; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, †Center for Clinical Investigation, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH; ‡Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; and §Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
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19
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Hong SH, Piao S, Kim IG, Lee JY, Cho HJ, Kim SW, Hwang TK, Lee JY. Comparison of three types of stress urinary incontinence rat models: electrocauterization, pudendal denervation, and vaginal distension. Urology 2013; 81:465.e1-6. [PMID: 23374842 DOI: 10.1016/j.urology.2012.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 09/03/2012] [Accepted: 10/17/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the differences in the histopathologic and functional characteristics of 3 rat models of stress urinary incontinence. MATERIALS AND METHODS A total of 24 female, 10-week-old, Sprague-Dawley rats were randomly divided into 4 groups: normal, electrocauterization, pudendal denervation, and vaginal distension. At 2 weeks after surgery, the leak point pressure was measured to detect urinary leakage. Urethral tissue samples were collected for histological examination. RESULTS The smooth muscle content in the electrocauterization group was significantly decreased compared with that in all other groups, indicating that electrocauterization caused the most severe injury. A blood vessel marker, von Willebrand factor, was co-stained with α-smooth muscle actin to detect the blood vessel distribution. No significant differences were seen in von Willebrand factor expression among the 4 groups, other than in the electrocauterization group, in which we could hardly observe blood vessel expression. Protein gene product 9.5 staining was used to detect nerve fibers and cells. Protein gene product 9.5 expression was significantly lower in all the treatment groups compared with that in the normal group (P <.05), in particular, in the electrocauterization and pudendal denervation groups (P <.01). The leak point pressure was significantly lower in the electrocauterization (P <.01), pudendal denervation (P <.01), and vaginal distension (P <.05) groups than in the normal group. CONCLUSION The vaginal distension model should mainly be used as the myogenic damage stress urinary incontinence animal model; the pudendal denervation model mainly as the neurogenic damage stress urinary incontinence animal model; and the electrocauterization model as the vasculogenic, neurogenic, and myogenic damage animal model.
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Affiliation(s)
- Sung-Hoo Hong
- Department of Urology, Catholic University of Korea College of Medicine, Seoul, Korea
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20
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Lenis AT, Kuang M, Woo LL, Hijaz A, Penn MS, Butler RS, Rackley R, Damaser MS, Wood HM. Impact of parturition on chemokine homing factor expression in the vaginal distention model of stress urinary incontinence. J Urol 2012; 189:1588-94. [PMID: 23022009 DOI: 10.1016/j.juro.2012.09.096] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/13/2012] [Indexed: 01/12/2023]
Abstract
PURPOSE Human childbirth simulated by vaginal distention is known to increase the expression of chemokines and receptors involved in stem cell homing and tissue repair. We hypothesized that pregnancy and parturition in rats contributes to the expression of chemokines and receptors after vaginal distention. MATERIALS AND METHODS We used 72 age matched female Lewis rats, including virgin rats with and without vaginal distention, and delivered rats with and without vaginal distention. Each rat was sacrificed immediately, or 3 or 7 days after vaginal distention and/or parturition, and the urethra was harvested. Relative expression of chemokines and receptors was determined by real-time polymerase chain reaction. Mixed models were used with the Bonferroni correction for multiple comparisons. RESULTS Vaginal distention up-regulated urethral expression of CCL7 immediately after injury in virgin and postpartum rats. Hypoxia inducible factor-1α and vascular endothelial growth factor were up-regulated only in virgin rats immediately after vaginal distention. CD191 expression was immediately up-regulated in postpartum rats without vaginal distention compared to virgin rats without vaginal distention. CD195 was up-regulated in virgin rats 3 days after vaginal distention compared to virgin rats without vaginal distention. CD193 and CXCR4 showed delayed up-regulation in virgin rats 7 days after vaginal distention. CXCL12 was up-regulated in virgin rats 3 days after vaginal distention compared to immediately after vaginal distention. Interleukin-8 and CD192 showed no differential expression. CONCLUSIONS Vaginal distention results in up-regulation of the chemokines and receptors expressed during tissue injury, which may facilitate the spontaneous functional recovery previously noted. Pregnancy and delivery up-regulated CD191 and attenuated the expression of hypoxia inducible factor-1α and vascular endothelial growth factor in the setting of vaginal distention, likely by decreasing hypoxia.
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Affiliation(s)
- Andrew T Lenis
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA
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21
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Sajadi KP, Lin DL, Steward JE, Balog B, Dissaranan C, Zaszczurynski P, Gill BC, Jiang HH, Kerns JM, Damaser MS. Pudendal nerve stretch reduces external urethral sphincter activity in rats. J Urol 2012; 188:1389-95. [PMID: 22906665 DOI: 10.1016/j.juro.2012.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Most animal models of stress urinary incontinence simulate maternal injuries of childbirth since delivery is a major risk factor but they do not reproduce the nerve stretch known to occur during human childbirth. We hypothesized that pudendal nerve stretch produces reversible dysfunction of the external urethral sphincter. MATERIALS AND METHODS Female virgin Sprague-Dawley® rats were anesthetized with urethane. Bilateral pudendal nerve stretch or sham injury was performed for 5 minutes. External urethral sphincter electromyography and leak point pressure were recorded immediately before and after, and 10, 30, 60 and 120 minutes after pudendal nerve stretch. Post-pudendal nerve stretch results were compared to prestretch values and to values in sham injured animals. The pudendal nerves underwent qualitative histological assessment. The nucleus of Onuf was evaluated by immunohistochemistry and polymerase chain reaction for β-APP and c-Fos expression as markers of neuronal activity and injury. RESULTS A total of 14 rats underwent bilateral pudendal nerve stretch (9) or sham injury (5). Each nerve was stretched a mean ± SEM of 74% ± 18% on the left side and 63% ± 13% on the right side. Electromyography amplitude decreased significantly immediately after stretch compared to before stretch and after sham injury (p = 0.003) but it recovered by 30 minutes after stretch. There was no significant change in leak point pressure at any time. Two hours after injury histology showed occasional neuronal degeneration. β-APP and c-Fos expression was similar in the 2 groups. CONCLUSIONS Acute pudendal nerve stretch produces reversible electrophysiological dysfunction but without leak point pressure impairment. Pudendal nerve stretch shows promise in modeling injury. It should be tested as part of a multi-injury, chronic, physiological model of human childbirth injury.
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Affiliation(s)
- Kamran P Sajadi
- Division of Urology, Oregon Health and Science University, Portland, Oregon 97232, USA.
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22
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Burdzińska A, Crayton R, Dybowski B, Koperski Ł, Idziak M, Fabisiak M, Pączek L, Radziszewski P. Urethral distension as a novel method to simulate sphincter insufficiency in the porcine animal model. Int J Urol 2012; 19:676-82. [PMID: 22548443 DOI: 10.1111/j.1442-2042.2012.02994.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe a novel animal model of intrinsic sphincter deficiency. METHODS The study was carried out on 10 female pigs. Injury to the urethral sphincter was induced by distension of the urethra. This was obtained by using the balloon of an 18-F Dufour catheter for 5 min followed by its retraction through the urethra without draining the balloon. The urethral pressure profile was evaluated before injury, immediately postinjury and at day 28 postinjury in the experimental group (n = 5), and on day 1 and day 28 in the control uninjured group (n = 5). The maximal urethral closure pressure, the functional urethral length and the area under curve of the urethral pressure profile were measured. RESULTS The mean maximal urethral closure pressure at the beginning of the experiment was 32 cmH(2) O, and the mean functional urethral length was 4.88 cm. The assessment at day 28 showed a reduction of the maximal urethral closure pressure (50% of the control, P > 0.05), the functional urethral length (52.5% of the control, P < 0.05) and the area under curve (52% of the control, P < 0.05) in injured pigs. Histologically, a fibrosis of the sphincter was detected without rupture of the muscle layer in all the samples. CONCLUSIONS The proposed porcine model can be used to obtain intrinsic sphincter deficiency-like urodynamic findings without rupturing the sphincter. This methodology can be applied to investigate therapies for intrinsic sphincter deficiency.
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Affiliation(s)
- Anna Burdzińska
- Department of Immunology, Transplantology and Internal Diseases, Transplantation Institute, Warsaw, Poland
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23
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Eaglen SAE, Coffey MP, Woolliams JA, Mrode R, Wall E. Phenotypic effects of calving ease on the subsequent fertility and milk production of dam and calf in UK Holstein-Friesian heifers. J Dairy Sci 2012; 94:5413-23. [PMID: 22032364 DOI: 10.3168/jds.2010-4040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 07/24/2011] [Indexed: 11/19/2022]
Abstract
The effect of calving ease on the fertility and production performance of both dam and calf was studied in approximately 50,000 and 10,000 UK Holstein-Friesian heifers and heifer calves, respectively. The first objective of this study was to estimate the effect of a difficult calving on the subsequent first-lactation milk production by estimating lactation curves using cubic splines. This methodology allows the estimation of daily milk, protein, and fat yields following calvings of differing degrees of difficulty. Losses in milk yield after a difficult calving have been quantified previously; however, estimates are generally restricted to the accumulated yields at specific days in lactation. By fitting cubic splines, gaps (in which the shape of the lactation curve can be merely guessed) between estimations were avoided. The second objective of this study was to estimate the effect of a difficult birth on the subsequent performance of the calf as an adult animal. Even though the calving process is known to involve cooperation between dam and calf, the effect of a difficult calving has, until now, only been estimated for the subsequent performance of the dam. Addressing the effects of a difficult birth on the adult calf strengthens the importance of calving ease as a selection trait because it suggests that the benefit of genetic improvement may currently be underestimated. The effect of calving ease on the subsequent reproductive performance of dam and calf was analyzed using linear regression and with calving ease score fitted as a fixed effect. Dams with veterinary-assisted calvings required 0.7 more services to conception and 8 more days to first service and experienced a 28-d longer calving interval in first lactation compared with dams that were not assisted at calving. Effects of calving ease on the reproductive performance of the adult calf in first lactation were not detected. Losses in milk yield of the dam were significant between d 9 to 90 in milk subsequent to a veterinary-assisted calving, creating a loss of approximately 2 kg of milk per day, compared with a nonassisted calving. Calves being born with difficulties showed a significant reduction in milk yield in first lactation, demonstrating the lifelong effect of a difficult birth. Compared with nonassisted calves, veterinary-assisted calves showed a loss of 710 kg in accumulated 305-d milk yield, which was significant from 129 to 261 d in milk. This suggests that from birth to production, physiological effects of a bad calving are not negated. Results furthermore suggest a beneficial effect of farmer assistance at calving on the milk yield of both dam and calf, when moderate difficulties occurred.
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Affiliation(s)
- S A E Eaglen
- Sustainable Livestock Systems Group, Scottish Agricultural College, Bush Estate, Penicuik, Midlothian, United Kingdom.
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Lin CS, Lue TF. Stem cell therapy for stress urinary incontinence: a critical review. Stem Cells Dev 2012; 21:834-43. [PMID: 22121849 DOI: 10.1089/scd.2011.0621] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Stress urinary incontinence (SUI) is a prevailing health problem that severely impacts quality of life. Because SUI is mainly due to urethral sphincter deficiency, several preclinical and clinical trials have investigated whether transplantation of patient's own skeletal muscle-derived cells (SkMDCs) can restore the sphincter musculature. The specific cell type of SkMDCs has been described as myoblasts, satellite cells, muscle progenitor cells, or muscle-derived stem cells, and thus may vary from study to study. In more recent years, other stem cell (SC) types have also been tested, including those from the bone marrow, umbilical cord blood, and adipose tissue. These studies were mostly preclinical and utilized rat SUI models that were established predominantly by pudendal or sciatic nerve injury. Less frequently used animal models were sphincter injury and vaginal distension. While transurethral injection of SCs was employed almost exclusively in clinical trials, periurethral injection was used in all preclinical trials. Intravenous injection was also used in one preclinical study. Functional assessment of therapeutic efficacy in preclinical studies has relied almost exclusively on leak point pressure measurement. Histological assessment examined the sphincter muscle content, existence of transplanted SCs, and possible differentiation of these SCs. While all of these studies reported favorable functional and histological outcomes, there are questions about the validity of the animal model and claims of multilineage differentiation. In any event, SC transplantation appears to be a promising treatment for SUI.
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Affiliation(s)
- Ching-Shwun Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California 94143-0738, USA.
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Combined ischemic and neuropathic insult to the anal canal in an animal model of obstetric-related trauma. Dis Colon Rectum 2012; 55:32-41. [PMID: 22156865 DOI: 10.1097/dcr.0b013e318236dcab] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Childbirth, in particular, when it involves instrumental vaginal delivery, can result in direct trauma to the external anal sphincter muscle. In addition, a global injury to the pelvic floor, including neurovascular injury to the anal sphincter complex, may occur. OBJECTIVE The aims of this study were to determine whether sensory drive from the anal canal and oxygenation of the external anal sphincter were compromised during simulated labor in a validated animal model of obstetric trauma. DESIGN Fifteen female Wister rats were operated on. Group 1 (n = 5) underwent pelvic balloon compression for 1 hour to simulate increased pelvic pressure during childbirth. Somatosensory cortical potentials, evoked by electrically stimulating the anal canal, were tracked. In group 2 (sham), the balloons were not inflated. In group 3, tissue PO2 values of the external anal sphincter and femoral arterial blood flow were measured simultaneously during the period of balloon inflation. RESULTS The peak amplitude of cortical evoked potentials was reduced (from 11.8 ± 1.5 μV to 3.1 ± 1.1 μV) during pelvic compression (p = 0.002, ANOVA). During this period, arterial blood flow to the hindlimb and the external anal sphincter tissue PO2 decreased by 20% (p < 0.001) and 60% (p < 0.001). CONCLUSION Pelvic compression that mimics obstetric trauma is associated with diminished anocortical drive. This neural insult may be compounded by concomitant ischemia of the external anal sphincter.
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Wang G, Lin G, Zhang H, Qiu X, Ning H, Banie L, Fandel T, Albersen M, Lue TF, Lin CS. Effects of prolonged vaginal distension and β-aminopropionitrile on urinary continence and urethral structure. Urology 2011; 78:968.e13-9. [PMID: 21982017 DOI: 10.1016/j.urology.2011.07.1381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 06/24/2011] [Accepted: 07/09/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effects of prolonged vaginal distension and β-aminopropionitrile (BAPN) on the urinary patterns and urethral structure in female virgin rats. METHODS A total of 21 female virgin rats were randomly divided into 3 groups of 7 rats each. The control group received no intervention; the vaginal distension (VD) group was treated with prolonged VD by balloon inflation; and the VD plus BAPN group was treated with VD plus intraperitoneal injection of 150 mg/kg of BAPN every 3 days. Three weeks later, all the rats underwent conscious cystometric analysis and were then killed for histologic analysis of the urethra. RESULTS Conscious cystometry identified 0, 3, and 5 rats in the control, VD, and VD plus BAPN groups with an abnormal voiding pattern, respectively. The urethral collagen content was significantly lower in the VD and VD plus BAPN rats compared with the control rats. The urethral elastic fibers were disorganized and shorter in the VD and VD plus BAPN rats and were fragmented and lacking the intermuscle connections in the VD plus BAPN rats. The urethral striated muscle fibers were shorter and more widely spaced in the VD and VD plus BAPN rats than in the control rats. Additionally, those in the VD plus BAPN group exhibited an abnormal wavy shape suggestive of a lack of architectural support. CONCLUSION Prolonged vaginal distension caused urodynamic changes and histologic abnormalities in the urethra, including reduced collagen content, fragmented elastic fibers, and sparsely arranged and shortened striated muscle fibers. BAPN appears to interfere with the restoration of collagen and elastic fibers.
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Affiliation(s)
- Guifang Wang
- Department of Urology, University of California, School of Medicine, San Francisco, CA, USA
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Kakizaki H, Kita M, Wada N. Models for sensory neurons of dorsal root ganglia and stress urinary incontinence. Neurourol Urodyn 2011; 30:653-7. [PMID: 21661009 DOI: 10.1002/nau.21138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS To discuss (1) animal models for investigating bladder afferent pathways from the spinal cord to the brain and (2) animal models of stress urinary incontinence (SUI) with a special emphasis on functional and histopathological characteristics of each model. METHODS Literature review of spinal mechanisms of bladder afferent pathways and animal models of SUI. RESULTS Electrophysiological studies in the rat using pelvic nerve stimulation and recording of evoked potentials in the periaqueductal gray (PAG) prove to be a valuable tool to examine spinal mechanisms of bladder afferent pathways. Animal models of SUI in the rat include vaginal distention as simulated birth trauma, pudendal nerve crush or transection, urethral sphincter injury by electrocauterization, transabdominal urethrolysis, periurethral botulinum-A toxin injection, and pubo-urethral ligament transection. Functional and histopathological changes in the continence mechanism after injury are different between models. CONCLUSIONS Using animal models for sensory neurons, intrathecal and intravenous administration of certain drugs can be tested whether they affect the bladder afferent pathways from the spinal cord to the PAG. Animal models of SUI can serve as a tool to develop new pharmacologic therapies or periurethral injection therapies using stem cell implants.
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Affiliation(s)
- Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan.
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Pelvic organ distribution of mesenchymal stem cells injected intravenously after simulated childbirth injury in female rats. Obstet Gynecol Int 2011; 2012:612946. [PMID: 21941558 PMCID: PMC3177359 DOI: 10.1155/2012/612946] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/26/2011] [Indexed: 12/30/2022] Open
Abstract
The local route of stem cell administration utilized presently in clinical trials for stress incontinence may not take full advantage of the capabilities of these cells. The goal of this study was to evaluate if intravenously injected mesenchymal stem cells (MSCs) home to pelvic organs after simulated childbirth injury in a rat model. Female rats underwent either vaginal distension (VD) or sham VD. All rats received 2 million GFP-labeled MSCs intravenously 1 hour after injury. Four or 10 days later pelvic organs and muscles were imaged for visualization of GFP-positive cells. Significantly more MSCs home to the urethra, vagina, rectum, and levator ani muscle 4 days after VD than after sham VD. MSCs were present 10 days after injection but GFP intensity had decreased. This study provides basic science evidence that intravenous administration of MSCs could provide an effective route for cell-based therapy to facilitate repair after injury and treat stress incontinence.
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Phull HS, Pan HQ, Butler RS, Hansel DE, Damaser MS. Vulnerability of continence structures to injury by simulated childbirth. Am J Physiol Renal Physiol 2011; 301:F641-9. [PMID: 21613415 DOI: 10.1152/ajprenal.00120.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The goal of this study was to examine acute morphological changes, edema, muscle damage, inflammation, and hypoxia in urethral and vaginal tissues with increasing duration of vaginal distension (VD) in a rat model. Twenty-nine virgin Sprague-Dawley rats underwent VD under anesthesia with the use of a modified Foley catheter inserted into the vagina and filled with saline for 0, 1, 4, or 6 h. Control animals were anesthetized for 4 h without catheter placement. Urogenital organs were harvested after intracardiac perfusion of fixative. Tissues were embedded, sectioned, and stained with Masson's trichrome or hematoxylin and eosin stains. Regions of hypoxia were measured by hypoxyprobe-1 immunohistochemistry. Within 1 h of VD, the urethra became vertically elongated and displaced anteriorly. Edema was most prominent in the external urethral sphincter (EUS) and urethral/vaginal septum within 4 h of VD, while muscle disruption and fragmentation of the EUS occurred after 6 h. Inflammatory damage was characterized by the presence of polymorphonuclear leukocytes in vessels and tissues after 4 h of VD, with the greatest degree of infiltration occurring in the EUS. Hypoxia localized mostly to the vaginal lamina propria, urethral smooth muscle, and EUS within 4 h of VD. Increasing duration of VD caused progressively greater tissue edema, muscle damage, and morphological changes in the urethra and vagina. The EUS underwent the greatest insult, demonstrating its vulnerability to childbirth injury.
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Affiliation(s)
- Hardeep S Phull
- Dept. of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic, OH 44195, USA
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Abstract
PURPOSE OF REVIEW Vaginal childbirth is a significant risk factor for stress urinary incontinence (SUI). Women with SUI demonstrate dysfunction of the pelvic floor and pudendal nerve. Animal models of SUI have been developed to investigate its pathophysiology and for preclinical testing of potential treatments. RECENT FINDINGS Vaginal distension, a method of simulating childbirth injury in animals, produces a reliable decrease in leak point pressure (LPP), a measure of urethral resistance to leakage and quantification of SUI severity in animals. In addition to ischemia and direct tissue damage, vaginal distension causes denervation of the external urethral sphincter (EUS). Pudendal nerve crush produces a similar decrease in LPP, whereas combined PNC and vaginal distension injury delays recovery of LPP compared with either single injury alone. Neurophysiologic studies have elucidated the results of each injury and their combination on pudendal nerve and EUS function. Urethrolysis, electrocautery, and pudendal nerve transection produce more durable functional impairment via both structural damage and denervation. Pubourethral ligament injury eliminates the structural support of the urethra, but its neurologic effects are unknown. SUMMARY Animal models demonstrate a complex interplay between tissue damage and pudendal nerve dysfunction, and provide insight into the importance of neuroregeneration in the recovery of continence.
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Abstract
Stress urinary incontinence (SUI) is a common health problem significantly affecting the quality of life of women worldwide. Animal models that simulate SUI enable the assessment of the mechanism of risk factors for SUI in a controlled fashion, including childbirth injuries, and enable preclinical testing of new treatments and therapies for SUI. Animal models that simulate childbirth are presently being utilized to determine the mechanisms of the maternal injuries of childbirth that lead to SUI with the goal of developing prophylactic treatments. Methods of assessing SUI in animals that mimic diagnostic methods used clinically have been developed to evaluate the animal models. Use of these animal models to test innovative treatment strategies has the potential to improve clinical management of SUI. This chapter provides a review of the available animal models of SUI, as well as a review of the methods of assessing SUI in animal models, and potential treatments that have been tested on these models.
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Affiliation(s)
- Hai-Hong Jiang
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Margot S. Damaser
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
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Breyer BN, Wang G, Lin G, Shindel AW, Yang R, Lin CS, Lue TF. The effect of long-term hormonal treatment on voiding patterns during filling cystometry and on urethral histology in a postpartum, ovariectomized female rat. BJU Int 2010; 106:1775-81. [PMID: 20201831 PMCID: PMC2912975 DOI: 10.1111/j.1464-410x.2010.09268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study whether long-term treatment with oestrogen (E(2) ), selective E(2) receptor modulators (SERMs), or growth hormone (GH) can prevent the development of abnormal voiding patterns during filling cystometry (CMG) in a postpartum, ovariectomized (Ovx) female rat. MATERIALS AND METHODS Immediately after spontaneous delivery, 60 primiparous Sprague-Dawley rats were randomly divided into six equal groups. One group served as uninjured sham controls and five groups underwent intravaginal balloon dilatation. On day seven, previously dilated rats underwent bilateral Ovx and implantation of a subcutaneous hormone-delivery pump. The five treatment groups received normal saline (control), E(2) , raloxifene, levormeloxifene, or GH for 7 weeks. Conscious CMG was performed 7 weeks after Ovx. Urethral sphincter tissue was harvested for elastin immunohistochemistry and real-time polymerase chain reaction of α(1A) -adrenoceptor mRNA. RESULTS No abnormal voiding patterns were detected in the group treated with GH. The E(2) , raloxifene and levormeloxifene groups had greater detrusor overactivity and urethral relaxation incontinence than control rats. The raloxifene group had a significantly lower baseline bladder pressure and opening pressure. GH-treated rats had higher elastin content in the urethra. Urethral α(1A) -adrenoceptor mRNA concentration was significantly lower in the SERM-treated rats compared with controls. CONCLUSIONS GH prevents the development of abnormal voiding patterns during filling CMG in a rat model of parturition-induced incontinence; E(2) and SERMs may worsen voiding patterns.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology, Knuppe Molecular Urology Laboratory, University of California, San Francisco, CA, USA
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Pan HQ, Lin DL, Strauch C, Butler RS, Monnier VM, Daneshgari F, Damaser MS. Pudendal nerve injury reduces urethral outlet resistance in diabetic rats. Am J Physiol Renal Physiol 2010; 299:F1443-50. [PMID: 20881033 DOI: 10.1152/ajprenal.00341.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diabetics have voiding and continence dysfunction to which elevated levels of advanced glycation end products (AGE) may contribute. In addition, pudendal nerve injury is correlated with voiding dysfunction and stress incontinence in rats. The aim of this study was to investigate whether pudendal nerve crush (PNC) in diabetic rats alters urinary function. Female virgin Sprague-Dawley rats (144) were divided equally into diabetic, diuretic, and control groups. Half of the animals in each group were subjected to PNC, and the other half to sham PNC. Diabetes was induced 8 wk before PNC or sham PNC by streptozotocin injection (35 mg/kg). Animals underwent conscious cystometry and leak point pressure (LPP) testing 4 or 13 days after PNC or sham PNC. Tissues of half the animals were tested for levels of AGEs. Qualitative histological assessment was performed in the remaining animals. Diabetic rats 4 days after PNC voided significantly greater volume in a shorter time and with significantly less pressure than after sham PNC, suggesting that diabetic rats have a functional outlet obstruction that is relieved by PNC. LPP was significantly reduced 4 days after PNC in diabetic and diuretic animals and returned to normal 13 days after PNC. Diabetic rats with PNC demonstrated increased muscle fiber disruption and atrophy of the external urethral sphincter. AGEs were significantly elevated in diabetic rats. PNC relieves a functional outlet obstruction in diabetic rats. AGEs are elevated in diabetic rats and could play a role in urinary dysfunction and recovery from PNC.
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Affiliation(s)
- Hui Q Pan
- Cleveland Clinic, Cleveland, OH 44195, USA
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Gill BC, Moore C, Damaser MS. Postpartum stress urinary incontinence: lessons from animal models. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2010; 5:567-580. [PMID: 21113428 PMCID: PMC2989536 DOI: 10.1586/eog.10.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44195, USA
| | - Courtenay Moore
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
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Bortolini MAT, Drutz HP, Lovatsis D, Alarab M. Vaginal delivery and pelvic floor dysfunction: current evidence and implications for future research. Int Urogynecol J 2010; 21:1025-30. [PMID: 20445961 DOI: 10.1007/s00192-010-1146-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/12/2010] [Indexed: 01/04/2023]
Abstract
Vaginal delivery is the major risk factor for the development of pelvic organ prolapse and urinary and fecal incontinence, resulting from damage to the pelvic floor muscles, nerves and connective tissue. This article reviews the perineal trauma mechanism during vaginal delivery and discusses implications of current and future research projects.
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Affiliation(s)
- M A T Bortolini
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada.
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Gasbarro G, Lin DL, Vurbic D, Quisno A, Kinley B, Daneshgari F, Damaser MS. Voiding function in obese and type 2 diabetic female rats. Am J Physiol Renal Physiol 2010; 298:F72-7. [DOI: 10.1152/ajprenal.00309.2009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The effects of obesity and type 2 diabetes (DMII) on the lower urinary tract (LUT) were characterized by evaluating voiding function and anatomy in female Zucker diabetic fatty (ZDF) rats. Age-matched female virgin rats were separated into three experimental groups: Zucker lean rats (control; normal diet, n = 22), ZDF rats (obese+nondiabetic; low-fat diet, n = 22), and ZDF rats (obese+diabetic; high-fat diet, n = 20). Rats were placed on their specified diet for 10 wk before urodynamic LUT evaluation. A suprapubic catheter was implanted 2 days before urodynamic studies. Voiding function was evaluated by cystometric and leak point pressure (LPP) testing. The bladder, urethra, and vagina were immediately excised for qualitative histological evaluation. Compared with control rats, obese+nondiabetic and obese+diabetic rats had significantly decreased contraction pressure ( P = 0.003) and increased cystometric filling volume ( P < 0.001). Both obese groups exhibited significantly higher voided volumes ( P = 0.003), less frequent urinary events ( P < 0.001), and increased residual volumes ( P = 0.039). LPP studies showed a nonsignificant decrease in LPP ( P = 0.075) and baseline pressure ( P = 0.168) in both obese groups compared with control. Histology of the external urethral sphincter in obese rats showed increased fibrosis, leading to disruption of the skeletal muscle structure compared with control. Additionally, the bladder wall of the obese+nondiabetic and obese+diabetic rats demonstrated edema and vasculopathy. Voiding dysfunction was evident in both obese groups but with no significant differences due to DMII, suggesting that voiding dysfunction in DMII may be attributable at least in part to chronic obesity.
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Affiliation(s)
- Gregory Gasbarro
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
- Department of Biomedical Engineering, Lerner Research Institute, and
| | - Dan Li Lin
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
| | - Drina Vurbic
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
| | - Amanda Quisno
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
| | - Bruce Kinley
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
| | - Firouz Daneshgari
- Department of Urology, University Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Margot S. Damaser
- Research Service, Louis B. Stokes Veterans Affairs Medical Center,
- Department of Biomedical Engineering, Lerner Research Institute, and
- Glickman Urological and Kidney Institute, Cleveland Clinic, and
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Woo LL, Hijaz A, Pan HQ, Kuang M, Rackley RR, Damaser MS. Simulated childbirth injuries in an inbred rat strain. Neurourol Urodyn 2009; 28:356-61. [PMID: 18973147 DOI: 10.1002/nau.20644] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS Vaginal distension (VD) in outbred rats has been shown to decrease urethral resistance, as well as increase the expression of the stem cell-homing chemokine, monocyte chemotactic factor 3 (MCP-3), but not stromal derived factor 1 (SDF-1). The aim of this study was to determine if similar responses are induced by VD in an inbred rat strain. METHODS Forty female Lewis rats underwent VD or sham VD followed by leak point pressure (LPP) testing 4 or 10 days later. Ten additional rats served as controls. The urethra and vagina were then dissected for histology. To examine chemokine expression, eight additional rats underwent VD with organs harvested immediately or 1 day after the procedure for reverse transcriptase polymerase chain reaction (RT-PCR) of MCP-3 and SDF-1. Four age-matched rats served as controls. RESULTS Four days after VD, LPP was significantly lower in VD rats (14.3 +/- 1.6 cm H(2)O) than controls (18.7 +/- 1.3 cm H(2)O). Ten days after VD, LPP in both VD (19.7 +/- 2.6 cm H(2)O) and sham (18.4 +/- 1.3 cm H(2)O) groups was not significantly different from controls. Urethral histology demonstrated marked disruption and atrophy of smooth and striated muscle in VD rats compared to shams and controls. RT-PCR yielded a 25-fold significant increase in expression of urethral MCP-3 immediately following VD. SDF-1 was significantly decreased in the urethra and vagina immediately after VD and in the bladder 24 hr after VD. CONCLUSION VD in Lewis rats produces functional, histological and molecular results similar to that of outbred rats. This model could be utilized in future studies investigating cellular transplant methods of improving urethral function.
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Affiliation(s)
- Lynn L Woo
- The Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Jiang HH, Pan HQ, Gustilo-Ashby MA, Gill B, Glaab J, Zaszczurynski P, Damaser M. Dual simulated childbirth injuries result in slowed recovery of pudendal nerve and urethral function. Neurourol Urodyn 2009; 28:229-35. [PMID: 18973146 DOI: 10.1002/nau.20632] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Pelvic floor muscle trauma and pudendal nerve injury have been implicated in stress urinary incontinence (SUI) development after childbirth. In this study, we investigated how combinations of these injuries affect recovery. METHODS Sixty-seven female Sprague-Dawley rats underwent vaginal distension (VD), pudendal nerve crush (PNC), PNC and VD (PNC + VD), pudendal nerve transection (PNT), or served as unmanipulated controls. Four days, 3 weeks, or 6 weeks after injury, we simultaneously recorded pudendal nerve motor branch potentials (PNMBP), external urethral sphincter electromyography (EUS EMG), and transurethral bladder pressure under urethane anesthesia. The presence of a guarding reflex (increased frequency and amplitude of PNMBP or EUS EMG activity) during leak point pressure (LPP) testing was determined. RESULTS Controls consistently demonstrated a guarding reflex. Four days after VD, EUS EMG activity was eliminated, but PNMBP activity reflected the guarding reflex; EUS EMG activity recovered after 3 weeks. Four days after PNC, both EUS EMG and PNMBP activity were eliminated, but demonstrated significant recovery at 3 weeks. Four days after PNC + VD both EUS EMG and nerve activity were eliminated, and little recovery was observed after 3 weeks with significant recovery of the guarding reflex 6 weeks after injury. Little recovery was observed at all time points after PNT. LPP results mirrored the reduction in EUS EMG activity. CONCLUSION Functional recovery occurs more slowly after PNC + VD than after either PNC or VD alone. Future work will be aimed at testing methods to facilitate neuroregeneration and recovery after this clinically relevant dual injury.
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Affiliation(s)
- Hai-Hong Jiang
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Minimizing the risk of childbirth-induced pelvic floor dysfunctions in the developing world: "preventive" urogynecology. Int Urogynecol J 2009; 20:615-7. [PMID: 19399354 DOI: 10.1007/s00192-009-0891-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 03/31/2009] [Indexed: 11/27/2022]
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Pan HQ, Kerns JM, Lin DL, Sypert D, Steward J, Hoover CRV, Zaszczurynski P, Butler RS, Damaser MS. Dual simulated childbirth injury delays anatomic recovery. Am J Physiol Renal Physiol 2008; 296:F277-83. [PMID: 19091786 DOI: 10.1152/ajprenal.90602.2008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dual childbirth injury model, including vaginal distension (VD) and pudendal nerve crush (PNC), may best represent the injuries seen clinically. The objective of this study was to investigate urethral function, anatomy, and neurotrophin expression after several simulated childbirth injuries. Groups of 140 rats underwent PNC, VD, PNC+VD, or neither (C). Four days after injury, all injury groups had significantly decreased leak-point pressure (LPP) compared with C rats. Ten days after injury, LPP in PNC and PNC+VD rats remained significantly lower than C rats. Three weeks after injury, LPP in all injury groups had recovered to C values. Histological evidence of injury was still evident in the external urethral sphincter (EUS) after VD and PNC+VD 10 days after injury. Three weeks after injury, the EUS of PNC+VD rats remained disrupted. One day after VD, brain-derived neurotrophic factor (BDNF) expression in the EUS was reduced, while neurotrophin-4 (NT-4) and nerve growth factor (NGF) expression was unchanged. BDNF, NT-4, and NGF expression was dramatically upregulated in the EUS after PNC. After PNC+VD, NGF expression was upregulated, and BDNF and NT-4 expression was upregulated somewhat but not to the same extent as after PNC. Ten days after injury, PNC+VD had the least number of normal nerve fascicles near the EUS, followed by PNC and VD. Twenty-one days after injury, all injury groups had fewer normal nerve fascicles, but without significant differences compared with C rats. PNC+VD therefore provides a more severe injury than PNC or VD alone.
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Affiliation(s)
- Hui Q Pan
- Cleveland Clinic, 9500 Euclid Ave., ND20, Cleveland, OH 44195, USA
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Jiang HH, Gustilo-Ashby AM, Salcedo LB, Pan HQ, Sypert DF, Butler RS, Damaser MS. Electrophysiological function during voiding after simulated childbirth injuries. Exp Neurol 2008; 215:342-8. [PMID: 19056383 DOI: 10.1016/j.expneurol.2008.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/27/2022]
Abstract
During vaginal delivery dual injuries of the pudendal nerve and the external urethral sphincter (EUS), along with other injuries, are correlated with later development of stress urinary incontinence. It is not known how combinations of these injuries affect neuromuscular recovery of the micturition reflex. We investigated the EUS electromyogram (EMG) and the pudendal nerve motor branch potentials (PNMBP) during voiding 4 days, 3 weeks or 6 weeks after injury; including vaginal distension (VD), pudendal nerve crush (PNC), both PNC and VD (PNC+VD), and pudendal nerve transection (PNT); and in controls. Pudendal nerve and urethral specimens were excised and studied histologically. No bursting activity was recorded in the EUS EMG during voiding 4 days after all injuries, as well as 3 weeks after PNC+VD. Bursting activity demonstrated recovery 3 weeks after either VD or PNC and 6 weeks after PNC+VD, but the recovered intraburst frequency remained significantly decreased compared to controls. Bursting results of PNMBP were similar to the EMG, except bursting in PNMBP 4 days after VD and the recovered intraburst frequency was significantly increased compared to controls after PNC and PNC+VD. After PNT, neither the EUS nor the pudendal nerve recovered by 6 weeks after injury. Our findings indicate bursting discharge during voiding recovers more slowly after PNC+VD than after either PNC or VD alone. This was confirmed histologically in the urethra and the pudendal nerve and may explain why pudendal nerve dysfunction has been observed years after vaginal delivery.
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Affiliation(s)
- Hai-Hong Jiang
- Biomedical Engineering Department, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
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Shoffstall AJ, Zaszczurynski PJ, Butler RS, Damaser MS. Development of a device to standardize leak point pressure experiments in rats. Neurourol Urodyn 2008; 27:553-8. [PMID: 18551566 DOI: 10.1002/nau.20591] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS The objective of this study was to test a custom device aimed at increasing repeatability of abdominal leak point pressure (LPP) measurements in rodents. METHODS The device consisted of a soft-tipped force applicator with a force sensor which was moved in the vertical direction by a linear actuator, laser crosshairs for accurate positioning, and a hand-held wired remote control system. One expert and two novice experimenters acquired LPP measurements using manual and device methods by applying a gradually increasing force with the finger or the device, respectively, until a leak was visually observed at the urethral meatus. The device was tested at fast, medium, and slow speeds. A leak sensor was also tested to determine presence of a leak and reaction time of the user. The change in bladder pressure due to the externally applied force (LPP) was the primary outcome. RESULTS There were no significant differences in mean LPP value when compared across experiments (expert, novice), method (manual, device), or speeds. The pooled variance of LPP was significantly decreased (P < 0.05) compared to the manual method when using the device at medium speed; however the slower speed showed no further improvement over the medium speed. The wet sensor detected leaks 385 +/- 187 msec earlier than users' reaction. CONCLUSIONS Use of the device can decrease variability of the experiment but does not alter mean values. Reaction time, inherent in both the manual and device methods, has the potential for a significant impact on LPP outcomes.
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Affiliation(s)
- Andrew J Shoffstall
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
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Tantiwongse K, Fandel TM, Wang G, Breyer BN, Walsh TJ, Bella AJ, Lue TF. The potential of hormones and selective oestrogen receptor modulators in preventing voiding dysfunction in rats. BJU Int 2008; 102:242-6. [PMID: 18336614 DOI: 10.1111/j.1464-410x.2008.07582.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether oestrogen, selective oestrogen receptor modulators (SERMs), and growth hormone (GH) can prevent the development of voiding dysfunction in a postpartum postmenopausal rat model of voiding dysfunction. MATERIALS AND METHODS Immediately after spontaneous delivery, nine primiparous Sprague-Dawley rats served as uninjured controls (sham group) and 54 underwent intravaginal balloon dilation. On day 7, the 54 subject rats underwent bilateral ovariectomy. A week later, six treatment groups of nine rats were randomized to receive: normal saline (injured control group), 17beta-oestradiol (E(2)), raloxifene, levormeloxifene, GH, or GH + E(2). The treatment groups received daily subcutaneous injections for 3 weeks. The effects of hormone treatment were examined by conscious cystometry at the end of the study. Voiding dysfunction was defined to include overactive bladder and sphincter deficiency. RESULTS The sham rats had a mean (sd) voiding frequency of 3 (0.87) times in 10 min and a bladder capacity of 0.43 (0.13) mL with smooth cystometry curves. The number of rats in each treatment group (each group contained nine rats) that had voiding dysfunction was as follows: E(2), three; raloxifene, six; levormeloxifene, four; and controls, four (P > 0.05 among the groups). Only one rat in the GH-treated group and no rats in the GH + E(2)-treated group had voiding dysfunction, which was significantly less in the GH + E(2)-treated group than in the controls (P = 0.041). CONCLUSION This functional data suggest that the development of voiding dysfunction can be prevented by short-term administration of GH and GH + E(2) in our rat model. SERMs and E(2) alone seem to have no therapeutic effect.
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Affiliation(s)
- Kavirach Tantiwongse
- Knuppe Molecular Urology Laboratory, Department of Urology, University of California-San Francisco, San Francisco, CA 94143-0738, USA
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Wood HM, Kuang M, Woo L, Hijaz A, Butler RS, Penn M, Rackley R, Damaser MS. Cytokine expression after vaginal distention of different durations in virgin Sprague-Dawley rats. J Urol 2008; 180:753-9. [PMID: 18554634 DOI: 10.1016/j.juro.2008.03.182] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Indexed: 02/03/2023]
Abstract
PURPOSE We investigated the effect of the duration of vaginal distention on the differential expression of stem cell homing, tissue repair cytokines and cytokine receptors to identify the factors most important for recovery from injury. MATERIALS AND METHODS A total of 20, 10-week-old virgin Sprague-Dawley rats were divided into 4 groups, including 1, 4 and 6-hour vaginal distention, and anesthetized sham operation. The vagina, bladder, urethra and rectum were harvested immediately after vaginal distention. Real-time polymerase chain reaction was used to determine the relative expression of cytokines and receptors of interest. Mixed models analysis was used to determine associations between expression levels and vaginal distention duration. RESULTS Positive associations between vaginal distention duration and the urethral expression level were found for 1 of the receptors of monocyte chemotactic protein-3, CCR1 (p = 0.0001) as well as for monocyte chemotactic protein-3 (p = 0.025), CCR5 (p = 0.032) and hypoxia inducible factor-1alpha (p = 0.023). A positive relationship between vaginal distention duration and monocyte chemotactic protein-3 expression was also observed in rectal tissue (p = 0.035). Urethral expression of CCR2, another receptor for monocyte chemotactic protein-3, approached significance (p = 0.066). An inverse relationship between vaginal distention duration and interleukin-8 expression was found in the bladder (p = 0.0008). No association was noted between vaginal distention duration and the expression of stromal derived factor-1, CXCR4, CCR3 and vascular endothelial growth factor in any pelvic organs. CONCLUSIONS These data support a relationship between vaginal distention duration and the subsequent expression of monocyte chemotactic protein-3 and 1 of its associated receptors, CCR1, in the urethra immediately following vaginal distention. The increase in hypoxia-inducible factor1alpha expression in the urethra with prolonged vaginal distention suggests a limited role of tissue ischemia in the immediate response of pelvic organs to vaginal distention.
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Affiliation(s)
- Hadley M Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Hijaz A, Daneshgari F, Sievert KD, Damaser MS. Animal models of female stress urinary incontinence. J Urol 2008; 179:2103-10. [PMID: 18423691 DOI: 10.1016/j.juro.2008.01.096] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE Urinary incontinence affects 40% of women in the United States and stress urinary incontinence accounts for a large portion of affected patients. As defined by the International Continence Society, stress urinary incontinence is the involuntary leakage of urine upon effort, exertion, sneezing or coughing. Since the ultimate success of long-term management for any condition is based on an understanding of its pathophysiology, and because the pathophysiology of stress urinary incontinence is incompletely defined, animal models have recently been developed to better understand stress urinary incontinence and develop novel treatment alternatives. MATERIALS AND METHODS Several animal models for urethral dysfunction have emerged in the last few years, including those based on pathophysiological theories of urethral sphincter dysfunction that were designed to simulate maternal birth trauma. Other models have focused on the creation of a durable model of dysfunction for investigating novel treatments. RESULTS Since animals cannot express intent, these animal models have focused on measuring decreased urethral resistance. The most widely used methods are the sneeze test, the tilt table technique and the leak point pressure test. Newer techniques include abdominal leak point pressure, urethral pressure measurement and retrograde urethral perfusion pressure. In addition to the advantages and disadvantages of each technique, all methods measure the composite contribution to urethral resistance from smooth and striated muscle, urethral closure and connective tissue, although none measures intent. CONCLUSIONS We critically reviewed the different models of stress urinary incontinence and urethral dysfunction as well as the different methods of measuring urethral resistance.
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Affiliation(s)
- Adonis Hijaz
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
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Damaser MS, Samplaski MK, Parikh M, Lin DL, Rao S, Kerns JM. Time course of neuroanatomical and functional recovery after bilateral pudendal nerve injury in female rats. Am J Physiol Renal Physiol 2007; 293:F1614-21. [PMID: 17728381 PMCID: PMC2528278 DOI: 10.1152/ajprenal.00176.2007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pudendal nerve innervates the external urethral sphincter (EUS) and is among the tissues injured during childbirth, which may lead to symptoms of stress urinary incontinence (SUI). To understand the mechanisms of injury and repair, urethral leak-point pressure (LPP) was measured 4 days, 2 wk, or 6 wk after bilateral pudendal nerve crush. Morphometric changes in the distal nerve and EUS were examined by light and electron microscopy. To determine whether recovery resulted from pudendal neuroregeneration, LPP was measured before and after pudendal nerve transection 2 wk after nerve crush. LPP was significantly decreased 4 days after pudendal nerve crush compared with sham-injured animals as well as 2 or 6 wk after nerve crush. LPP was not significantly different 2 or 6 wk after nerve crush compared with sham-injured animals, suggesting that urethral function had returned to normal. Four days after pudendal nerve crush, the EUS branch of the pudendal nerve distal to the injury site showed evidence of nerve degeneration and the EUS appeared disrupted. Two weeks after nerve crush, the distal nerve and EUS both showed evidence of both nerve degeneration and recovery. Two weeks after nerve crush, LPP was significantly decreased after nerve transection. Six weeks after nerve injury, evidence of neuroregeneration was observed in the pudendal nerve and the EUS. This study has demonstrated that functional recovery and neuroregeneration are significant 2 wk after nerve crush, although by anatomical assessment, recovery appears incomplete, suggesting that 2 wk represents an early time point of initial neuroregeneration.
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Affiliation(s)
- Margot S Damaser
- Dept. of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., ND20, Cleveland, OH 44195, USA
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