Urinary cytokines in women with refractory detrusor overactivity: A longitudinal study of rotating antibiotic versus placebo treatment

A Cross Sectional Study of Cytokines in Women with Refractory Detrusor Overactivity versus Controls

INTRODUCTION AND HYPOTHESIS

Previous work has suggested that refractory detrusor overactivity (DO) was commonly associated with urinary tract infection (UTI), which can lead to inflammatory changes in the bladder. This study aimed to investigate the concentrations of urinary cytokines in a large sample of women with refractory detrusor overactivity (DO) and age matched controls.

METHODS

The urinary concentration of 27 cytokines in 140 women (95 with refractory DO and 45 age matched controls (women without urge incontinence)) was determined using the Human Cytokine 27-plex Assay. Cytokine concentrations were correlated with a "UTI score", the presence or absence of bacteriuria or pyuria on the day of sample collection and a previous history of UTI.

RESULTS

Pro-inflammatory cytokines were increased in refractory DO women compared to the controls. In women with refractory DO, the UTI score significantly correlated with urinary cytokine concentrations in 15 of the 22 cytokines detected. A previous history of UTI did not affect urinary cytokine concentrations in refractory DO women with no current UTI. Increasing pyuria was associated with increasing concentrations of urinary cytokines.

CONCLUSION

Careful comparison of cytokine concentrations in women with refractory DO versus age matched controls has shown that changes in pro-inflammatory cytokines are related to the UTI disease burden, suggesting that an underlying inflammatory response, together with UTI, may be an aetiological contributor to the development of refractory DO.

Effect of pro-inflammatory cytokines on urothelial cell adenosine triphosphate release and breakdown

Objectives

Urinary symptoms of urgency, frequency, and pain are thought to be the result of inflammation in several bladder pathologies although the cause of these symptoms remains uncertain. Extracellular adenosine triphosphate (ATP) released from the bladder urothelium during normal bladder stretch is believed to bind to purinergic receptors on afferent nerves to signal bladder sensation. This study examined pro-inflammatory cytokines in the urine of women with detrusor overactivity (DO) with or without urinary tract infection (UTI) compared to controls and then determined the effect of pro-inflammatory cytokines on ATP signaling (release and breakdown) from the urothelium.

Methods

The urinary concentrations of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) were determined in women with DO with or without UTI compared to female controls. The effect of pro-inflammatory cytokines (IFN-γ, TNF-α, and IL-1β) on control and hypotonic-induced ATP release using human UROtsa urothelial cells was examined, as was the effect of these cytokines on nucleotide (ATP, adenosine diphosphate and adenosine monophosphate) breakdown.

Results

Urinary concentrations of IFN-γ, TNF-α, and IL-1β were increased in women with DO and UTI. Pre-treatment of urothelial cells with individual cytokines stimulated a decrease rather than an increase in ATP release whereas pre-treatment with a cocktail of all three cytokines stimulated a small but significant increase in hypotonic-induced ATP release. Pre-treatment of urothelial cells with cytokines significantly enhanced nucleotide breakdown.

Conclusion

Using a simple cell culture model we have demonstrated that the response of the urothelium to pro-inflammatory cytokines is complex, affecting both release and breakdown of ATP.

The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018

Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine the correlation between OAB and the systemic immunity-inflammation index (SII) in the USA. We analyzed data from 31,881 participants in the National Health and Nutrition Examination Survey 2005-2018. SII, calculated as platelet count × neutrophil count/lymphocyte count, was categorized into quartiles. OAB was defined by the presence of urge urinary incontinence and nocturia. Weighted logistic regression models were used to examine the independent relationship between SII and OAB, adjusting for demographic factors, kidney function, and diabetes status. The results showed that each tenfold increase in log-transformed SII was associated with an 18% higher odds of OAB (OR 1.18, 95% CI 1.08-1.28) in the fully adjusted model. Compared to the lowest SII quartile, the highest quartile had a 28% increased OAB risk (OR 1.28, 95% CI 1.12-1.47). The positive association between SII and OAB risk was consistently observed across subgroups stratified by age, sex, race, marital status, education, and poverty level. Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB.

Urinary Tract Infection in Overactive Bladder: An Update on Pathophysiological Mechanisms

Overactive bladder (OAB) is a clinical syndrome defined by urinary urgency, increased daytime urinary frequency and/or nocturia, with or without urinary incontinence, that affects approximately 11% of the western population. OAB is accepted as an idiopathic disorder, and is charactersied clinically in the absence of other organic diseases, including urinary tract infection. Despite this, a growing body of research provides evidence that a significant proportion of OAB patients have active bladder infection. This review discusses the key findings of recent laboratory and clinical studies, providing insight into the relationship between urinary tract infection, bladder inflammation, and the pathophysiology of OAB. We summarise an array of clinical studies that find OAB patients are significantly more likely than control patients to have pathogenic bacteria in their urine and increased bladder inflammation. This review reveals the complex nature of OAB, and highlights key laboratory studies that have begun to unravel how urinary tract infection and bladder inflammation can induce urinary urgency and urinary frequency. The evidence presented in this review supports the concept that urinary tract infection may be an underappreciated contributor to the pathophysiology of some OAB patients.