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Lamb LE, Janicki JJ, Bartolone SN, Ward EP, Abraham N, Laudano M, Smith CP, Peters KM, Zwaans BMM, Chancellor MB. Risk Classification for Interstitial Cystitis/Bladder Pain Syndrome Using Machine Learning Based Predictions. Urology 2024; 189:19-26. [PMID: 38677373 DOI: 10.1016/j.urology.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To improve diagnosis of interstitial cystitis (IC)/bladder pain syndrome(IC) we hereby developed an improved IC risk classification using machine learning algorithms. METHODS A national crowdsourcing resulted in 1264 urine samples consisting of 536 IC (513 female, 21 male, 2 unspecified), and 728 age-matched controls (318 female, 402 male, 8 unspecified) with corresponding patient-reported outcome (PRO) pain and symptom scores. In addition, 296 urine samples were collected at three academic centers: 78 IC (71 female, 7 male) and 218 controls (148 female, 68 male, 2 unspecified). Urinary cytokine biomarker levels were determined using Luminex assay. A machine learning predictive classification model, termed the Interstitial Cystitis Personalized Inflammation Symptom (IC-PIS) Score, that utilizes PRO and cytokine levels, was generated and compared to a challenger model. RESULTS The top-performing model using biomarker measurements and PROs (area under the curve [AUC]=0.87) was a support vector classifier, which scored better at predicting IC than PROs alone (AUC=0.83). While biomarkers alone (AUC=0.58) did not exhibit strong predictive performance, their combination with PROs produced an improved predictive effect. CONCLUSION IC-PIS represents a novel classification model designed to enhance the diagnostic accuracy of IC/bladder pain syndrome by integrating PROs and urine biomarkers. The innovative approach to sample collection logistics, coupled with one of the largest crowdsourced biomarker development studies utilizing ambient shipping methods across the US, underscores the robustness and scalability of our findings.
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Affiliation(s)
- Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester, MI; Strata Oncology, Ann Arbor, MI
| | | | | | - Elijah P Ward
- Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | | | | | | | - Kenneth M Peters
- Oakland University William Beaumont School of Medicine, Rochester, MI; Underactive Bladder Foundation, Pittsburgh, PA; Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Bernadette M M Zwaans
- Oakland University William Beaumont School of Medicine, Rochester, MI; Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Michael B Chancellor
- Oakland University William Beaumont School of Medicine, Rochester, MI; Corewell Health William Beaumont University Hospital, Royal Oak, MI.
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Lemmon B, Kyrgiou M, Mullins E, Khullar V. Cytokines in Bladder Pain Syndrome: A Review of the Literature. Int Urogynecol J 2024; 35:1119-1129. [PMID: 38771505 DOI: 10.1007/s00192-024-05778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome (BPS) is poorly understood with both the aetiology and pathophysiology being unknown. Symptoms overlap with other disorders, such as overactive bladder (OAB) and chronic pelvic pain disorders such as endometriosis, making a consensus on how to diagnosis and manage patients challenging. The development of biomarkers for BPS may be the key to understanding more about its pathophysiology, as well as aiding diagnosis, subclassification, and discovering new drug targets for its management. As inflammation is widely understood to hold a central role in BPS, the evaluation of cytokines has gained interest. This article summarises the current literature and understanding of urinary, serum, and bladder tissue cytokines found elevated in patients with bladder pain syndrome. METHODS literature search using Pub Med with the keywords "bladder pain syndrome", "painful bladder syndrome", "bladder pain", "Interstitial cystitis" AND "cytokines" or "inflammation". This study was except from institutional approval. RESULTS Thirty-six cytokines have been identified as being statistically significantly elevated in either the serum, urine, or bladder tissue of patients with bladder pain syndrome in the 22 studies identified in this review of the literature. These cytokines include those from the interleukin group (n = 14), the CXC chemokine group (n = 5), and the C-C chemokine group (n = 7). CONCLUSIONS CXCL-1, CXCL-8, CXCL-9, CXCL-10, CXCL-11 from the CXC chemokine group, and CCL2, CCL4, CCL5, CCL7, and CCL11 from the C-C chemokine group have been found to be significantly elevated in patients with bladder pain in the literature. Many of these analytes also have supporting evidence for their roles in bladder pain from animal models and studies in other chronic inflammatory conditions. It is likely that a single cytokine will not serve as an adequate biomarker of disease in bladder pain syndrome for either diagnosis or disease severity. Instead, panels of inflammatory mediators may reveal more about the different pathways of inflammation leading to similar presentations of bladder pain in patients.
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Affiliation(s)
- Bernadette Lemmon
- Urogynaecology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK.
| | - Maria Kyrgiou
- IRDB, Department of Metabolism, Digestion and Reproduction-Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Urogynaecology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - Vikram Khullar
- Urogynaecology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
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Zwaans BMM, Mota S, Bartolone SN, Ward EP, Peters KM, Chancellor MB. Evaluating symptom severity and urinary cytokine levels in interstitial cystitis/bladder pain syndrome patients, with and without Hunner's lesions. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:110-118. [PMID: 38736620 PMCID: PMC11087211 DOI: 10.62347/bled2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized in part by urinary urgency, frequency, and pain. There is a strong interest in gathering more data to compare and assess the differences in characteristics based on the presence of Hunner's lesions in patients with IC/BPS. MATERIALS AND METHODS Using a nationwide crowdsource effort, we collected surveys and urine samples from patients with a history of IC/BPS. Participants completed the Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), Overactive Bladder questionnaire (OABq SF), and pain scores. In addition, participants reported any co-morbidities and lifestyle modifications. Urinary cytokine levels were measured and compared to symptom severity. RESULTS 491 participants enrolled: 119 with history of ulcerative Hunner's lesions (UIC), 372 reported no lesions (NHIC), and 2 unknowns. 96.3% were female, and prevalence of UIC was equal for both genders. Average age was higher for UIC vs. NHIC group (P = 0.011), as was the duration since diagnosis (P < 0.001). Symptom scores were elevated in UIC patients (P < 0.001). Both groups widely implemented lifestyle modifications, with dietary changes being most prevalent (70.1%), followed by prescription medication usage (63.1%). More UIC compared to NHIC participants experienced co-morbidities (P = 0.010). Urine samples were analyzed for GRO, IL-6, IL-8, and MCP-1. MCP-1 levels were significantly higher in UIC patients (P = 0.044). Weak positive correlation was found between cytokines and symptom scores. CONCLUSIONS Patients with UIC and NHIC from across the United States displayed distinct phenotypic and urine biological characteristics. These findings contribute to increased understanding of IC/BPS and may aid in improving our knowledge of the condition.
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Affiliation(s)
- Bernadette MM Zwaans
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Sabrina Mota
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Sarah N Bartolone
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Elijah P Ward
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Kenneth M Peters
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Michael B Chancellor
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
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Onoja A, von Gerichten J, Lewis HM, Bailey MJ, Skene DJ, Geifman N, Spick M. Meta-Analysis of COVID-19 Metabolomics Identifies Variations in Robustness of Biomarkers. Int J Mol Sci 2023; 24:14371. [PMID: 37762673 PMCID: PMC10531504 DOI: 10.3390/ijms241814371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
The global COVID-19 pandemic resulted in widespread harms but also rapid advances in vaccine development, diagnostic testing, and treatment. As the disease moves to endemic status, the need to identify characteristic biomarkers of the disease for diagnostics or therapeutics has lessened, but lessons can still be learned to inform biomarker research in dealing with future pathogens. In this work, we test five sets of research-derived biomarkers against an independent targeted and quantitative Liquid Chromatography-Mass Spectrometry metabolomics dataset to evaluate how robustly these proposed panels would distinguish between COVID-19-positive and negative patients in a hospital setting. We further evaluate a crowdsourced panel comprising the COVID-19 metabolomics biomarkers most commonly mentioned in the literature between 2020 and 2023. The best-performing panel in the independent dataset-measured by F1 score (0.76) and AUROC (0.77)-included nine biomarkers: lactic acid, glutamate, aspartate, phenylalanine, β-alanine, ornithine, arachidonic acid, choline, and hypoxanthine. Panels comprising fewer metabolites performed less well, showing weaker statistical significance in the independent cohort than originally reported in their respective discovery studies. Whilst the studies reviewed here were small and may be subject to confounders, it is desirable that biomarker panels be resilient across cohorts if they are to find use in the clinic, highlighting the importance of assessing the robustness and reproducibility of metabolomics analyses in independent populations.
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Affiliation(s)
- Anthony Onoja
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (A.O.); (N.G.)
| | - Johanna von Gerichten
- School of Chemistry and Chemical Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK; (J.v.G.); (M.J.B.)
| | - Holly-May Lewis
- School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (H.-M.L.); (D.J.S.)
| | - Melanie J. Bailey
- School of Chemistry and Chemical Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK; (J.v.G.); (M.J.B.)
| | - Debra J. Skene
- School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (H.-M.L.); (D.J.S.)
| | - Nophar Geifman
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (A.O.); (N.G.)
| | - Matt Spick
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (A.O.); (N.G.)
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Hoang Roberts L, Zwaans BM, Peters KM, Chancellor M, Padmanabhan P. Incidence of New or Worsening Overactive Bladder Among Patients with a Prior SARS-CoV-2 Infection: A Cohort Study. EUR UROL SUPPL 2022; 46:68-74. [PMID: 36245790 PMCID: PMC9554342 DOI: 10.1016/j.euros.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background Literature is sparse on COVID-19-associated cystitis (CAC), a novel condition comprising frequency, urgency, and nocturia after COVID-19 infection. Objective To determine the incidence of CAC and correlation with SARS-CoV-2 antibody levels. Design setting and participants This was a retrospective study in which urinary symptoms were scored using the International Consultation on Incontinence Questionnaire-overactive bladder (ICIQ-OAB) at three time points: before the pandemic (January 2020), 2 mo after COVID-19 infection (if applicable), and at the time of the study (May 2021). The setting was a regional health care system. The 18 785 healthcare employees who took part in the BLAST COVID study group were invited to participate, of whom 1895 responded. Outcome measurements and statistical analysis The outcome measured was the percentage of COVID-positive patients with a significant change on ICIQ-OAB over time. Pearson's χ2 test was used for comparison of categorical data, and one-way analysis of variance for continuous data and multivariate analysis. A sample size of 618 was calculated for power of 80% and α = 0.05. Results and limitations Of the 1895 participants, 31.9% (n = 605) were positive for COVID-19 according to positive serology or a polymerase chain reaction (PCR) test. Of these, 492 were PCR-positive and had 2-mo postinfection data, with 36.4% (179/492) reporting an increase of ≥1 point on the ICIQ-OAB compared to baseline (before the pandemic), with de novo OAB in 22% of these cases (40/179). Comparison of symptoms between baseline and the study time revealed that 27.4% (31/113) of those with positive serology only (asymptomatic COVID) and 37.8% (186/492) of those with PCR positivity (symptomatic COVID) had an increase of ≥1 point on the ICIQ-OAB, compared to 15.8% (n = 204) of uninfected patients, with odds ratios of 2.013 (95% confidence interval [CI] 1.294-3.138; p = 0.0015) and 3.236 (95% CI 2.548-4.080; p < 0.0001), respectively. The retrospective nature of the study and the volunteer sample are limitations. Conclusions COVID-19 infection increases the risk of developing new or worsening OAB symptoms. Patient summary We compared overactive bladder symptoms in a large group of participants between individuals with and without a previous COVID-19 infection. We found that symptomatic infection was associated with a three times greater risk of developing new or worsening overactive bladder symptoms among COVID-19 patients.
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Affiliation(s)
- Ly Hoang Roberts
- Corresponding author. Department of Urology, Oakland University William Beaumont School of Medicine, Beaumont Hospital-Royal Oak, 3535 W. 13 Mile Road, Royal Oak, MI 48073, USA. Tel. +1 405 3260972.
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Ward EP, Bartolone SN, Sharma P, Chancellor MB, Lamb LE. Using social media to crowdsource collection of urine samples during a national pandemic. Int Urol Nephrol 2022; 54:493-498. [PMID: 35080680 PMCID: PMC8790544 DOI: 10.1007/s11255-022-03108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic and subsequent lockdown had a substantial impact on normal research operations. Researchers needed to adapt their methods to engage at-home participants. One method is crowdsourcing, in which researchers use social media to recruit participants, gather data, and collect samples. We utilized this method to develop a diagnostic test for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Participants were recruited via posts on popular social-media platforms, and enrolled via a website. Participants received and returned a mail kit containing bladder symptom surveys and a urine sample cup containing room-temperature preservative. Using this method, we collected 1254 IC/BPS and control samples in 3 months from all 50 United States. Our data demonstrate that crowdsourcing is a viable alternative to traditional research, with the ability to reach a broad patient population rapidly. Crowdsourcing is a powerful tool for at-home participation in research, particularly during the lockdown caused by the COVID-19 pandemic.
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Affiliation(s)
| | | | - Prasun Sharma
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Michael B Chancellor
- Beaumont Health, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Laura E Lamb
- Beaumont Health, Royal Oak, MI, USA. .,Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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Chancellor M, Lamb L, Ward E, Bartolone S, Carabulea A, Sharma P, Janicki J, Smith C, Laudano M, Abraham N, M. Zwaans B. Comparing concentration of urinary inflammatory cytokines in interstitial cystitis, overactive bladder, urinary tract infection, and bladder cancer. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Lai HH, Newcomb C, Harte S, Appleby D, Ackerman AL, Anger JT, Nickel JC, Gupta P, Rodriguez LV, Landis JR, Clemens JQ. Comparison of deep phenotyping features of UCPPS with and without Hunner lesion: A MAPP-II Research Network Study. Neurourol Urodyn 2021; 40:810-818. [PMID: 33604963 DOI: 10.1002/nau.24623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To use the phenotyping data from the MAPP-II Symptom Patterns Study (SPS) to compare the systemic features between urologic chronic pelvic pain syndrome (UCPPS) with Hunner lesion (HL) versus those without HL. METHODS We performed chart review on 385 women and 193 men with UCPPS who enrolled in the MAPP-II SPS. 223 had cystoscopy and documentation of HL status. Among them, 12.5% had HL and 87.5% did not. RESULTS UCPPS participants with HL were older, had increased nocturia, higher Interstitial Cystitis Symptom and Problem Indexes, and were more likely to report "painful urgency" compared with those without HL. On the other hand, UCPPS without HL reported more intense nonurologic pain, greater distribution of pain outside the pelvis, greater numbers of comorbid chronic overlapping pain conditions, higher fibromyalgia-like symptoms, and greater pain centralization, and were more likely to have migraine headache than those with HL. UCPPS without HL also had higher anxiety, perceived stress, and pain catastrophizing than those with HL. There were no differences in sex distribution, UCPPS symptom duration, intensity of urologic pain, distribution of genital pain, pelvic floor tenderness on pelvic examination, quality of life, depression, pain characteristics (nociceptive pain vs. neuropathic pain), mechanical hypersensitivity in the suprapubic area during quantitative sensory testing, and 3-year longitudinal pain outcome and urinary outcome between the two groups. CONCLUSIONS UCPPS with HL displayed more bladder-centric symptom profiles, while UCPPS without HL displayed symptoms suggesting a more systemic pain syndrome. The MAPP-II SPS phenotyping data showed that Hunner lesion is a distinct phenotype from non-Hunner lesion.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Craig Newcomb
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steve Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dina Appleby
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - A Lenore Ackerman
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jennifer T Anger
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Larissa V Rodriguez
- Departments of Urology, and Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - J Richard Landis
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Chancellor M, Lamb L. Toward a validated diagnostic test with machine learning algorithm for interstitial cystitis. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_155_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lamb LE, Dhar N, Timar R, Wills M, Dhar S, Chancellor MB. COVID-19 inflammation results in urine cytokine elevation and causes COVID-19 associated cystitis (CAC). Med Hypotheses 2020; 145:110375. [PMID: 33213997 PMCID: PMC7644255 DOI: 10.1016/j.mehy.2020.110375] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Coronavirus disease 2019 (COVID-19) causes a wide range of symptoms, including several unexpected symptoms such as loss of taste, skin changes, and eye problems. We recently observed patients with documented COVID-19 develop de novo severe genitourinary symptoms, most notably urinary frequency of ≥ 13 episodes/24 h and nocturia ≥ 4 episodes/night. We call these associated urinary symptoms COVID-19 associate cystitis (CAC). COVID-19 severity is associated with inflammation. We collected urine samples from COVID-19 patients, including patients with CAC, and found elevation of proinflammatory cytokines also in the urine. It has been previously shown that patients with urinary incontinence and ulcerative interstitial cystitis/bladder pain syndrome have elevated urinary inflammatory cytokines compared to normal controls. We therefore hypothesize that CAC, with presentation of de novo severe urinary symptoms, can occur in COVID-19 and is caused by increased inflammatory cytokines that are released into the urine and/or expressed in the bladder. The most important implications of our hypothesis are: 1) Physician caring for COVID-19 patients should be aware of COVID-19 associate cystitis (CAC); 2) De novo urinary symptoms should be included in the symptom complex associated with COVID-19; and 3) COVID-19 inflammation may result in bladder dysfunction.
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Affiliation(s)
- Laura E Lamb
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA.
| | - Nivedita Dhar
- Detroit Medical Center, Detroit, MI, USA; John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Ryan Timar
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Melissa Wills
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Sorabh Dhar
- John D. Dingell VA Medical Center, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael B Chancellor
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
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Zwaans BMM, Nicolai HE, Chancellor MB, Lamb LE. Prostate cancer survivors with symptoms of radiation cystitis have elevated fibrotic and vascular proteins in urine. PLoS One 2020; 15:e0241388. [PMID: 33119677 PMCID: PMC7595289 DOI: 10.1371/journal.pone.0241388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/13/2020] [Indexed: 01/22/2023] Open
Abstract
Radiation for pelvic cancers can result in severe bladder damage and radiation cystitis (RC), which is characterized by chronic inflammation, fibrosis, and vascular damage. RC development is poorly understood because bladder biopsies are difficult to obtain. The goal of this study is to gain understanding of molecular changes that drive radiation-induced cystitis in cancer survivors using urine samples from prostate cancer survivors with history of radiation therapy. 94 urine samples were collected from prostate cancer survivors with (n = 85) and without (n = 9) history of radiation therapy. 15 patients with radiation history were officially diagnosed with radiation cystitis. Levels of 47 different proteins were measured using Multiplex Luminex. Comparisons were made between non-irradiated and irradiated samples, and within irradiated samples based on radiation cystitis diagnosis, symptom scores or hematuria. Statistical analysis was performed using Welch’s t-test. In prostate cancer survivors with history of radiation therapy, elevated levels of PAI 1, TIMP1, TIMP2, HGF and VEGF-A were detected in patients that received a radiation cystitis diagnosis. These proteins were also increased in patients suffering from hematuria or high symptom scores. No inflammatory proteins were detected in the urine, except in patients with gross hematuria and end stage radiation cystitis. Active fibrosis and vascular distress is detectable in the urine through elevated levels of associated proteins. Inflammation is only detected in urine of patients with end-stage radiation cystitis disease. These results suggest that fibrosis and vascular damage drive the development of radiation cystitis and could lead to the development of more targeted treatments.
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Affiliation(s)
- Bernadette M. M. Zwaans
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, United States of America
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - Heinz E. Nicolai
- Departamento de Urología, Universidad de Chile, Santiago, Chile
- Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Michael B. Chancellor
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, United States of America
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - Laura E. Lamb
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, United States of America
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
- * E-mail:
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Tyagi P, Moon CH, Janicki J, Kaufman J, Chancellor M, Yoshimura N, Chermansky C. Recent advances in imaging and understanding interstitial cystitis. F1000Res 2018; 7. [PMID: 30473772 PMCID: PMC6234747 DOI: 10.12688/f1000research.16096.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 12/30/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition associated with intense pelvic pain and bladder storage symptoms. Since diagnosis is difficult, prevalence estimates vary with the methodology used. There is also a lack of proven imaging tools and biomarkers to assist in differentiation of IC/BPS from other urinary disorders (overactive bladder, vulvodynia, endometriosis, and prostatitis). Current uncertainty regarding the etiology and pathology of IC/BPS ultimately impacts its timely and successful treatment, as well as hampers future drug development. This review will cover recent developments in imaging methods, such as magnetic resonance imaging, that advance the understanding of IC/BPS and guide drug development.
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Affiliation(s)
- Pradeep Tyagi
- Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
| | - Chan-Hong Moon
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
| | | | | | | | - Naoki Yoshimura
- Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA
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Zwaans BMM, Bartolone SN, Chancellor MB, Nicolai HE, Lamb LE. Altered Angiogenic Growth Factors in Urine of Prostate Cancer Survivors With Radiation History and Radiation Cystitis. Urology 2018; 120:180-186. [PMID: 30059715 DOI: 10.1016/j.urology.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if the vascular damage in bladders of prostate cancer (PCa) survivors with radiation cystitis can be detected through altered angiogenic growth factors in urine. METHODS Urine samples from PCa survivors with a history of external beam radiation therapy were tested for a panel of angiogenic growth factors by Luminex assay. Urine creatinine levels were measured through high performance liquid chromatography. Through a patient survey, data on patient demographics, radiation history, and urinary symptoms were collected. RESULTS Hepatocyte growth factor (HGF), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) were altered in urine of PCa survivors with a history of radiation therapy. HGF and PlGF were elevated in response to irradiation, while VEGF had a decreasing trend. Within the irradiated population, HGF was also increased in patients diagnosed with radiation cystitis and patients with hematuria. PlGF and VEGF were only increased in the first year postirradiation, and VEGF was elevated in patients with hematuria. Finally, creatinine levels were increased in PCa survivors with a history of radiation therapy. CONCLUSION Radiation cystitis is a debilitating bladder condition that cancer survivors are at risk of developing after pelvic radiation. In this study, we identified 3 pro-angiogenic factors that may be urine biomarkers and, if validated in future studies, could indicate new strategy approaches to treat radiation cystitis.
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Affiliation(s)
- Bernadette M M Zwaans
- Department of Urology, William Beaumont Hospital, MI; Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | - Michael B Chancellor
- Department of Urology, William Beaumont Hospital, MI; Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Heinz E Nicolai
- Urology Department, University of Chile, Santiago, Chile; Clinical Hospital San Borja Arriarán, Santiago, Chile
| | - Laura E Lamb
- Department of Urology, William Beaumont Hospital, MI; Oakland University William Beaumont School of Medicine, Royal Oak, MI.
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Chancellor MB, Bartolone SN, Veerecke A, Lamb LE. Crowdsourcing Disease Biomarker Discovery Research: The IP4IC Study. J Urol 2017; 199:1344-1350. [PMID: 29225061 DOI: 10.1016/j.juro.2017.09.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Biomarker discovery is limited by readily assessable, cost efficient human samples available in large numbers that represent the entire heterogeneity of the disease. We developed a novel, active participation crowdsourcing method to determine BP-RS (Bladder Permeability Defect Risk Score). It is based on noninvasive urinary cytokines to discriminate patients with interstitial cystitis/bladder pain syndrome who had Hunner lesions from controls and patients with interstitial cystitis/bladder pain syndrome but without Hunner lesions. MATERIALS AND METHODS We performed a national crowdsourcing study in cooperation with the Interstitial Cystitis Association. Patients answered demographic, symptom severity and urinary frequency questionnaires on a HIPAA (Health Insurance Portability and Accountability Act) compliant website. Urine samples were collected at home, stabilized with a preservative and sent to Beaumont Hospital for analysis. The expression of 3 urinary cytokines was used in a machine learning algorithm to develop BP-RS. RESULTS The IP4IC study collected a total of 448 urine samples, representing 153 patients (147 females and 6 males) with interstitial cystitis/bladder pain syndrome, of whom 54 (50 females and 4 males) had Hunner lesions. A total of 159 female and 136 male controls also participated, who were age matched. A defined BP-RS was calculated to predict interstitial cystitis/bladder pain syndrome with Hunner lesions or a bladder permeability defect etiology with 89% validity. CONCLUSIONS In this novel participation crowdsourcing study we obtained a large number of urine samples from 46 states, which were collected at home, shipped and stored at room temperature. Using a machine learning algorithm we developed BP-RS to quantify the risk of interstitial cystitis/bladder pain syndrome with Hunner lesions, which is indicative of a bladder permeability defect etiology. To our knowledge BP-RS is the first validated urine biomarker assay for interstitial cystitis/bladder pain syndrome and one of the first biomarker assays to be developed using crowdsourcing.
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Affiliation(s)
- Michael B Chancellor
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan.
| | | | - Andrew Veerecke
- Department of Urology, Beaumont Health System, Royal Oak, Michigan
| | - Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan
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