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Kwon J, Kim DY, Cho KJ, Hashimoto M, Matsuoka K, Kamijo T, Wang Z, Karnup S, Robertson AM, Tyagi P, Yoshimura N. Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives. Int Neurourol J 2024; 28:12-33. [PMID: 38461853 DOI: 10.5213/inj.2448002.001] [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: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective disorder, urinary microbiome, localized and systemic inflammatory responses, etc. Several hypotheses have been suggested as mechanisms of OAB generation; among them, neurogenic, myogenic, and urothelial mechanisms are well-known hypotheses. Also, a series of local signals called autonomous myogenic contraction, micromotion, or afferent noises, which can occur during bladder filling, may be induced by the leak of acetylcholine (ACh) or urothelial release of adenosine triphosphate (ATP). They can be transmitted to the central nervous system through afferent fibers to trigger coordinated urgency-related detrusor contractions. Antimuscarinics, commonly known to induce smooth muscle relaxation by competitive blockage of muscarinic receptors in the parasympathetic postganglionic nerve, have a minimal effect on detrusor contraction within therapeutic doses. In fact, they have a predominant role in preventing signals in the afferent nerve transmission process. β3-adrenergic receptor (AR) agonists inhibit afferent signals by predominant inhibition of mechanosensitive Aδ-fibers in the normal bladder. However, in pathologic conditions such as spinal cord injury, it seems to inhibit capsaicin-sensitive C-fibers. Particularly, mirabegron, a β3-agonist, prevents ACh release in the BOO-induced detrusor overactivity model by parasympathetic prejunctional mechanisms. A recent study also revealed that vibegron may have 2 mechanisms of action: inhibition of ACh from cholinergic efferent nerves in the detrusor and afferent inhibition via urothelial β3-AR.
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Affiliation(s)
- Joonbeom Kwon
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Leaders Urology Clinic, Daegu, Korea
| | - Duk Yoon Kim
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kang Jun Cho
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mamoru Hashimoto
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kanako Matsuoka
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tadanobu Kamijo
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sergei Karnup
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh School of Bioengineering, Pittsburgh, PA, USA
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Gao X, Jin X, Wang W, Di X, Peng L, Li H, Liao B, Wang K. β-Adrenoceptors regulate urothelial inflammation and zonula occludens in the bladder outlet obstruction model. Int Immunopharmacol 2024; 127:111371. [PMID: 38103410 DOI: 10.1016/j.intimp.2023.111371] [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: 09/11/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effects of β-adrenoceptors (ADRBs) on the urothelial inflammation and zonula occludens (ZO) in a rat PBOO model and in an in vitro model. METHODS The PBOO model was established by ligating the bladder neck of rats. Twenty rats were divided into 4 groups: sham operation, PBOO + normal saline, PBOO + ADRB2 agonist, PBOO + ADRB3 agonist. PBOO rats were with treated with ADRBs agonists for 3 weeks. Human urothelial cells (HUCs) were subjected to ADRBs agonist treatment or hydrostatic pressure in an in vitro model. RESULTS In the PBOO group, there was a significant increase in the expression of MCP-1, IL-6 and RANTES compared to the sham group. By contrast, there was a post-PBOO decline in the expression of ZO-1 and ZO-2 in the urothelium. ADRB2 or ADRB3 agonists exhibited downregulated inflammatory cytokine expression and increased ZO expression in the PBOO model. The regulation of inflammation and ZO by ADRB2 and ADRB3 agonists in an in vitro model was found consistent with that in the PBOO model. Moreover, RhoA and ROCK inhibitors suppressed the expression of hydrostatic pressure-induced inflammatory cytokines. Additionally, RhoA agonist reversed the inhibitory effect of ADRBs agonists on the inflammatory secretion from HUCs. CONCLUSIONS ADRB2 and ADRB3 agonists increased ZO protein expression in HUCs in a rat PBOO model and in an in vitro model. Furthermore, ADRB2 and ADRB3 agonists inhibited the secretion of inflammatory cytokines from HUCs by regulating the RhoA/ROCK signaling pathways.
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Affiliation(s)
- Xiaoshuai Gao
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xi Jin
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Wei Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xingpeng Di
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liao Peng
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Li
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Banghua Liao
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Kunjie Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Di X, Jin X, Ai J, Xiang L, Gao X, Xiao K, Li H, Luo D, Wang K. YAP/Smad3 promotes pathological extracellular matrix microenviroment-induced bladder smooth muscle proliferation in bladder fibrosis progression. MedComm (Beijing) 2022; 3:e169. [PMID: 36176734 PMCID: PMC9477793 DOI: 10.1002/mco2.169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
Fibrosis is a chronic inflammation process with excess extracellular matrix (ECM) deposition that cannot be reversed. Patients suffer from bladder dysfunction caused by bladder fibrosis. Moreover, the interactive mechanisms between ECM and bladder fibrosis are still obscure. Hence, we assessed the pivotal effect of Yes-associated protein (YAP) on the proliferation of bladder smooth muscle in fibrosis process. We identified that stiff ECM increased the expression and translocation of YAP in the nucleus of human bladder smooth muscle cell (hBdSMC). Sequencings and proteomics revealed that YAP bound to Smad3 and promoted the proliferation of hBdSMC via MAPK/ERK signaling pathway in stiff ECM. Moreover, CUT and TAG sequencing and dual-luciferase assays demonstrated that Smad3 inhibited the transcription of JUN. The YAP inhibitor CA3 was used in a partial bladder outlet obstruction (pBOO) rat model. The results showed that CA3 attenuated bladder smooth muscle proliferation. Collectively, YAP binding with Smad3 in the nucleus inhibited the transcription of JUN, and promoted the proliferation of bladder smooth muscle through the MAPK/ERK signaling pathway. The current study identified a novel mechanism of mechanical force induced bladder fibrosis that provided insights in YAP-associated organ fibrosis.
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Affiliation(s)
- Xing‐Peng Di
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Jian‐Zhong Ai
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Li‐Yuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Xiao‐Shuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Kai‐Wen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - De‐Yi Luo
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Kun‐Jie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology)West China Hospital, Sichuan UniversityChengduSichuanChina
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4
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Chen G, Chen S, Di X, He S, Liu Y, Qu R, Luo Y, Liu Y, Yang L. Survivin knockdown alleviates pathological hydrostatic pressure-induced bladder smooth muscle cell dysfunction and BOO-induced bladder remodeling via autophagy. Front Cell Dev Biol 2022; 10:999547. [PMID: 36393846 PMCID: PMC9649584 DOI: 10.3389/fcell.2022.999547] [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: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 09/05/2023] Open
Abstract
Aim: Bladder outlet obstruction (BOO) leads to bladder wall remodeling accompanying the progression from inflammation to fibrosis where pathological hydrostatic pressure (HP)-induced alteration of bladder smooth muscle cells (BSMCs) hypertrophic and excessive extracellular matrix (ECM) deposition play a pivotal role. Recently, we have predicted survivin (BIRC5) as a potential hub gene that might be critical during bladder fibrosis by bioinformatics analyses from rat BOO bladder, but its function during BOO progression remains unknown. Here, we investigated the role of survivin protein on bladder dysfunction of BOO both in vitro and in vivo. Methods: Sprague-Dawley female rats were divided into three groups: control group, BOO group, and BOO followed by the treatment with YM155 group. Bladder morphology and function were evaluated by Masson staining and urodynamic testing. To elucidate the underlying mechanism, hBSMCs were subjected to pathological HP of 200 cm H2O and co-cultured with the presence or absence of survivin siRNA and/or autophagy inhibitor 3-MA. Autophagy was evaluated by the detection of Beclin1 and LC3B-II expression, proliferation was conducted by the EdU analysis and PCNA expression, and fibrosis was assessed by the examination of Col 1 and Fn expression. Results: BOO led to a gradual alteration of hypertrophy and fibrosis of the bladder, and subsequently induced bladder dysfunction accompanied by increased survivin expression, while these histological and function changes were attenuated by the treatment with YM155. HP significantly increased survivin expression, upregulated Col1 and Fn expression, enhanced proliferation, and downregulated autophagy markers, but these changes were partially abolished by survivin siRNA treatment, which was consistent with the results of the BOO rat experiment. In addition, the anti-fibrotic and anti-proliferative effects of the survivin siRNA treatment on hBSMCs were diminished after the inhibition of autophagy by the treatment with 3-MA. Conclusion: In summary, the upregulation of survivin increased cell proliferation and fibrotic protein expression of hBSMC and drove the onset of bladder remodeling through autophagy during BOO. Targeting survivin in pathological hBSMCs could be a promising way to anti-fibrotic therapeutic approach in bladder remodeling secondary to BOO.
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Affiliation(s)
- Guo Chen
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Laboratory of Reconstructive Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Shuang Chen
- Laboratory of Reconstructive Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Xingpeng Di
- Laboratory of Reconstructive Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Shengyin He
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yugao Liu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rui Qu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yi Luo
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuebai Liu
- Department of Education and Training, Sichuan Cancer Hospital, Chengdu, China
| | - Luo Yang
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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5
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Liang CC, Huang WC, Shaw SW, Huang YH, Lee TH. Human amniotic fluid stem cells can alleviate detrusor dysfunction caused by bladder outlet obstruction in rats. Sci Rep 2022; 12:6679. [PMID: 35461349 PMCID: PMC9035144 DOI: 10.1038/s41598-022-10640-y] [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: 09/25/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
The present study examined whether bladder detrusor dysfunction due to partial bladder outlet obstruction (pBOO) could be improved after the treatment of human amniotic fluid stem cells (hAFSCs). 72 female rats were grouped into sham operation, pBOO, and pBOO with hAFSCs treatment (pBOO + hAFSCs) for in vitro and in vivo studies. Bladder weight, bladder wall thickness, the ratio of collagen to smooth muscle and the levels of positive CD11b/c and HIS48 cells was significantly increased after pBOO but improved after hAFSCs treatment. Cystometries showed impaired bladder function after pBOO. Protein and mRNA levels of hypoxia inducible factor-1α, CCL2, interleukin-1β, transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), α-smooth muscle actin, collagen I and collagen III were increased at 2 and/or 6 weeks, but proteins and mRNA expressions of protein gene product 9.5 were decreased at 2 and 6 weeks after pBOO. These abnormalities were improved after hAFSCs treatment. The expressions of TGF-β1 and CTGF in cultured detrusor cells of pBOO rats were increased but were improved after hAFSCs treatment. The present results showed hAFSCs treatment could improve bladder detrusor dysfunction in pBOO rats, which may be related to the reduction of inflammatory and pro-fibrotic markers in detrusor muscle cells.
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Affiliation(s)
- Ching-Chung Liang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chu Huang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Steven W Shaw
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Obstetrics, Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan.,Prenatal Cell and Gene Therapy Group, Institute for Women's Health, University College London, London, UK
| | - Yung-Hsin Huang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsing Street, Kweishan, 33333, Taoyuan, Taiwan.
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6
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Sidler M, Aitken KJ, Jiang JX, Yadav P, Lloyd E, Ibrahim M, Choufani S, Weksberg R, Bägli D. Inhibition of DNA methylation during chronic obstructive bladder disease (COBD) improves function, pathology and expression. Sci Rep 2021; 11:17307. [PMID: 34453065 PMCID: PMC8397724 DOI: 10.1038/s41598-021-96155-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023] Open
Abstract
Partial bladder outlet obstruction due to prostate hyperplasia or posterior urethral valves, is a widespread cause of urinary dysfunction, patient discomfort and also responsible for immense health care costs. Even after removal or relief of obstruction, the functional and pathologic aspects of obstruction remain as a chronic obstructive bladder disease (COBD). Epigenetic changes, such as DNA methylation, contribute to the persistent character of many chronic diseases, and may be altered in COBD. We tested whether candidate genes and pathways and the pathophysiology of COBD were affected by a hypomethylating agent, decitabine (DAC). COBD was created in female Sprague-Dawley rats by surgical ligation of the urethra for 6 weeks, followed by removal of the suture. Sham ligations were performed by passing the suture behind the urethra. After removal of the obstruction or sham removal, animals were randomized to DAC treatment (1 mg/kg/3-times/week intraperitoneally) or vehicle (normal saline). Bladder function was non-invasively tested using metabolic cages, both one day prior to de-obstruction at 6 weeks and prior to sacrifice at 10 weeks. Residual volume and bladder mass were measured for each bladder. Bladders were examined by immunostaining as well as qPCR. The effects of DNA methyltransferase (DNMT)-3A knockout or overexpression on smooth muscle cell (SMC) function and phenotype were also examined in bladder SMC and ex vivo culture. Residual volumes of the DAC treated group were not significantly different from the NS group. Compared to COBD NS, COBD DAC treatment helped preserve micturition volume with a significant recovery of the voiding efficiency (ratio of the maximum voided volume/maximum bladder capacity) by one third (Fig. 1, p > 0.05). Brain-derived neurotrophic factor (BDNF) variants 1 and 5 were upregulated by COBD and significantly reduced by DAC treatment. Deposition of collagen in the COBD bladder was reduced by DAC, but gross hypertrophy remained. In bladder SMC, DNMT3A overexpression led to a loss of contractile function and phenotype. In bladders, persistently altered by COBD, inhibition of DNA-methylation enhances functional recovery, unlike treatment during partial obstruction, which exacerbates obstructive pathology. The underlying mechanisms may relate to the gene expression changes in BDNF and their effects on signaling in the bladder.
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Affiliation(s)
- Martin Sidler
- Paediatric and Neonatal Surgery, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - K J Aitken
- Developmental and Stem Cell Biology, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada.
| | - Jia-Xin Jiang
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, New PMSSY Rd, Raibareli Rd, Lucknow, Uttar Pradesh, 226014, India
| | - Erin Lloyd
- Developmental and Stem Cell Biology, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada
| | - Malak Ibrahim
- Developmental and Stem Cell Biology, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada
| | - Sanaa Choufani
- Genetics and Genome Biology, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada
| | - Rosanna Weksberg
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Darius Bägli
- Urology Division, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Dietary reversal reverts diet-induced alterations in obstructed bladders of Wistar rats. Nutrition 2021; 89:111346. [PMID: 34166895 DOI: 10.1016/j.nut.2021.111346] [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: 02/10/2021] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the effects of diet reversal to standard chow on diet-induced changes in structure and function of normal and obstructed bladders in male Wistar rats. METHODS Eighty animals were equally divided into sham-surgery and bladder outlet obstruction (BOO) dietary groups and fed standard chow (control), high-carbohydrate, high-fat, and high-protein diets. BOO groups had surgically induced BOO, whereas sham surgery was performed on sham groups at the end of week 8. Animals were continued on the treatment diets for 4 wk after surgery, then the diets were all changed to standard chow for the remainder of the study period. Bladder weight, detrusor contractility, Rho-associated protein kinase (Rho-kinase), and myosin light chain kinase were determined. Polymerase chain reaction was used to assay for transforming growth factor-β, connecting tissue growth factor, hypoxia-inducible factor-1α, and platelet-derived growth factor subunit A levels in the bladder. C-reactive protein, insulin-like growth factor-1, nerve growth factor, and C-X-C motif chemokine ligand 12 concentrations were determined by enzyme-linked immunosorbent assay. The collagen content of the bladder was estimated by liquid chromatography/mass spectrometry. RESULTS Reversal of diet to standard chow resulted in reversal of diet-induced changes in all variables measured in obstructed bladders. High-fat-diet-induced alterations in normal bladders were also reversed. CONCLUSION The results suggested that in obstructed bladders of animals, reversal of the diet could reverse all diet-associated changes that increase inflammation and fibrosis in obstructed bladders. This is especially important in changes related to high consumption of fatty diets and associated lower urinary tract symptoms.
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Chen S, Liao B, Jin X, Wei T, He Q, Lin Y, Ai J, Gong L, Li H, Wang K. M
3
receptor modulates extracellular matrix synthesis via ERK1/2 signaling pathway in human bladder smooth muscle cells. J Cell Biochem 2020; 121:4496-4504. [PMID: 32065420 DOI: 10.1002/jcb.29688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Shulian Chen
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
- Department of Urology Affiliated Hospital of Zunyi Medical University Zunyi Guizhou China
| | - Banghua Liao
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Xi Jin
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Tangqiang Wei
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Qing He
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Yifei Lin
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Jianzhong Ai
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Lina Gong
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Hong Li
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
| | - Kunjie Wang
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology West China Hospital, Sichuan University Chengdu Sichuan China
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9
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Can Botulinum Toxin A Still Have a Role in Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Through Inhibition of Chronic Prostatic Inflammation? Toxins (Basel) 2019; 11:toxins11090547. [PMID: 31546892 PMCID: PMC6784075 DOI: 10.3390/toxins11090547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with benign prostatic hyperplasia (BPH) can exhibit various lower urinary tract symptoms (LUTS) owing to bladder outlet obstruction (BOO), prostatic inflammation, and bladder response to BOO. The pathogenesis of BPH involves an imbalance of internal hormones and chronic prostatic inflammation, possibly triggered by prostatic infection, autoimmune responses, neurogenic inflammation, oxidative stress, and autonomic dysfunction. Botulinum toxin A (BoNT-A) is well recognized for its ability to block acetylcholine release at the neuromuscular junction by cleaving synaptosomal-associated proteins. Although current large clinical trials have shown no clinical benefits of BoNT-A for the management of LUTS due to BPH, BoNT-A has demonstrated beneficial effects in certain subsets of BPH patients with LUTS, especially in males with concomitant chronic prostatitis/chronic pelvic pain syndrome and smaller prostate. We conducted a review of published literature in Pubmed, using Botulinum toxin, BPH, BOO, inflammation, LUTS, and prostatitis as the key words. This article reviewed the mechanisms of BPH pathogenesis and anti-inflammatory effects of BoNT-A. The results suggested that to achieve effectiveness, the treatment of BPH with BoNT-A should be tailored according to more detailed clinical information and reliable biomarkers.
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10
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Affas S, Schäfer FM, Algarrahi K, Cristofaro V, Sullivan MP, Yang X, Costa K, Sack B, Gharaee-Kermani M, Macoska JA, Gundogdu G, Seager C, Estrada CR, Mauney JR. Augmentation Cystoplasty of Diseased Porcine Bladders with Bi-Layer Silk Fibroin Grafts. Tissue Eng Part A 2018; 25:855-866. [PMID: 30191762 DOI: 10.1089/ten.tea.2018.0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPACT STATEMENT The search for an ideal "off-the-shelf" biomaterial for augmentation cystoplasty remains elusive and current scaffold configurations are hampered by mechanical and biocompatibility restrictions. In addition, preclinical evaluations of potential scaffold designs for bladder repair are limited by the lack of tractable large animal models of obstructive bladder disease that can mimic clinical pathology. The results of this study describe a novel, minimally invasive, porcine model of partial bladder outlet obstruction that simulates clinically relevant phenotypes. Utilizing this model, we demonstrate that acellular, bi-layer silk fibroin grafts can support the formation of vascularized, innervated bladder tissues with functional properties.
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Affiliation(s)
- Saif Affas
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Frank-Mattias Schäfer
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts
| | - Khalid Algarrahi
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Vivian Cristofaro
- 3 Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts.,4 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maryrose P Sullivan
- 3 Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts.,4 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Xuehui Yang
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts
| | - Kyle Costa
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts
| | - Bryan Sack
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Mehrnaz Gharaee-Kermani
- 5 Department of Biological Sciences, Center for Personalized Cancer Therapy, The University of Massachusetts, Boston, Massachusetts
| | - Jill A Macoska
- 5 Department of Biological Sciences, Center for Personalized Cancer Therapy, The University of Massachusetts, Boston, Massachusetts
| | - Gokhan Gundogdu
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Catherine Seager
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Carlos R Estrada
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Joshua R Mauney
- 1 Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, Boston, Massachusetts.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts
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11
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Fusco F, Creta M, De Nunzio C, Iacovelli V, Mangiapia F, Li Marzi V, Finazzi Agrò E. Progressive bladder remodeling due to bladder outlet obstruction: a systematic review of morphological and molecular evidences in humans. BMC Urol 2018; 18:15. [PMID: 29519236 PMCID: PMC5844070 DOI: 10.1186/s12894-018-0329-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bladder outlet obstruction is a common urological condition. We aimed to summarize available evidences about bladder outlet obstruction-induced molecular and morphological alterations occurring in human bladder. METHODS We performed a literature search up to December 2017 including clinical and preclinical basic research studies on humans. The following search terms were combined: angiogenesis, apoptosis, bladder outlet obstruction, collagen, electron microscopy, extracellular matrix, fibrosis, hypoxia, histology, inflammation, innervation, ischemia, pressure, proliferation, remodeling, suburothelium, smooth muscle cells, stretch, urothelium. RESULTS We identified 36 relevant studies. A three-stages model of bladder wall remodeling can be hypothesized involving an initial hypertrophy phase, a subsequent compensation phase and a later decompensation. Histological and molecular alterations occur in the following compartments: urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, nerves. Cyclic stretch, increased hydrostatic and cyclic hydrodynamic pressure and hypoxia are stimuli capable of modulating multiple signaling pathways involved in this remodeling process. CONCLUSIONS Bladder outlet obstruction leads to progressive bladder tissue remodeling in humans. Multiple signaling pathways are involved.
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Affiliation(s)
- Ferdinando Fusco
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Massimiliano Creta
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Cosimo De Nunzio
- Dipartimento di Urologia, Ospedale Sant’Andrea, Università Degli Studi di Roma “La Sapienza”, Rota, Italy
| | - Valerio Iacovelli
- Dipartimento di Medicina Sperimentale e Chirurgia, Università Degli Studi di Roma “Tor Vergata”, Roma, Italy
| | - Francesco Mangiapia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Di Napoli Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Vincenzo Li Marzi
- Dipartimento di Urologia, Ospedale Careggi, Università Degli Studi di Firenze, Firenze, Italy
| | - Enrico Finazzi Agrò
- Dipartimento di Medicina Sperimentale e Chirurgia, Università Degli Studi di Roma “Tor Vergata”, Roma, Italy
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12
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Ye C, Cai Y, Cai Q, Yuan S, Huang F, Yang X, He S, Li Z, Wang Y, Yang D, Li Z. High glucose induces the proliferation of prostatic cells via downregulating MRE11. Int J Mol Med 2018. [PMID: 29532862 PMCID: PMC5881645 DOI: 10.3892/ijmm.2018.3549] [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] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to investigate the candidate genes and pathways associated with benign prostatic hyperplasia (BPH) and diabetes. In vitro experiments were performed using normal prostatic epithelial RWPE-1 and HPr-1 cells. The cell lines were treated with a high-glucose solution and MTS and bromodeoxyuridine assays were used to assess cell viability. Transcriptome sequencing was used to screen the candidate genes. The expression of candidate genes was further verified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. A meiotic recombination 11 (MRE11) overexpression vector was designed and transfected into RWPE-1 cells to verify the function of MRE11. A streptozotocin-induced diabetic rat model was established and rat MRE11 levels were determined by RT-qPCR and immunohistochemical staining. High concentrations of glucose resulted in RWPE-1 and HPr-1 cells with high viability. Transcriptome sequencing revealed that MRE11 was downregulated when RWPE-1 cells were exposed to high-glucose conditions. When MRE11 was overexpressed, cell viability decreased and cell apoptosis was induced under high-glucose conditions. Prostatic tissues from rats were collected and assessed; MRE11 expression was observed to be decreased, which was consistent with the in vitro cell experiments. BPH may be associated with diabetes, as MRE11 expression in prostatic cells was decreased when exposed to high-glucose conditions. Therefore, MRE11 may have potential as a biomarker for the early diagnosis of BPH and diabetes.
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Affiliation(s)
- Chunwei Ye
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Yi Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qian Cai
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Shunhui Yuan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Fan Huang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Xiaofang Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Shuchen He
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Zhuoheng Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Yanwen Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Delin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Zhipeng Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
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Gadelkareem RA, Shahat AA, Abdelhafez MF, Moeen AM, Ibrahim AS, Safwat AS. Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children. Urol Int 2018; 101:85-90. [PMID: 29874665 DOI: 10.1159/000488398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra. MATERIALS AND METHODS Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied. RESULTS Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. CONCLUSIONS Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.
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Affiliation(s)
- Rabea A Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Shahat
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed F Abdelhafez
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Moeen
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrady S Ibrahim
- Department of Anesthesia and Intensive Care, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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14
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Sezginer EK, Yilmaz-Oral D, Lokman U, Nebioglu S, Aktan F, Gur S. Effects of varying degrees of partial bladder outlet obstruction on urinary bladder function of rats: A novel link to inflammation, oxidative stress and hypoxia. Low Urin Tract Symptoms 2017; 11:O193-O201. [PMID: 29282885 DOI: 10.1111/luts.12211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate the effects of different degrees of obstruction, and the roles of inflammation, oxidative stress, and hypoxia parameters on bladder function. METHODS Thirty male Sprague-Dawley rats were divided into 3 groups (n = 10 in each group): (i) sham-operated control; (ii) severe partial bladder outlet obstruction (PBOO); and (iii) moderate PBOO. Severe and moderate PBOO were induced by urethral ligation using 3-Fr and 4-Fr catheters, respectively, for 6 weeks. After 6 weeks, the in vitro contractile responses to carbachol, electrical field stimulation, ATP and KCl were measured in bladder strips. In addition, mRNA and protein expression of nuclear factor kappa B (NF-κB) hypoxia-inducible factor (HIF) and nuclear factor, erythroid 2-like 2 (Nrf2) in bladder were determined by real-time polymerase chain reaction and western blotting. Malondialdehyde (MDA) levels in bladder tissues were also determined. RESULTS Rats in the severe PBOO group had the highest bladder weight. Detrusor strips from rats in the severe PBOO group exhibited 61%-82% smaller contractile responses to all four stimuli than those from the sham-operated group. Activity of NF-κB as an inflammatory marker was increased in the severe PBOO group, whereas HIF-1α and HIF-2β protein levels were increased significantly in the moderate PBOO group. A master regulator of oxidative stress, Nrf2 expression was increased in all obstructed rats. MDA levels were higher in the severe PBOO group than in sham-operated group. CONCLUSION The results of the present study reveal the importance of oxidative stress-induced NF-κB signaling in bladder dysfunction with severe obstruction. Altered HIF signaling may contribute to the functional impairment after PBOO. Novel and evolving therapies targeting oxidative and/or inflammatory pathways may be a reasonable strategy for the management of lower urinary tract symptoms or benign prostatic hyperplasia.
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Affiliation(s)
- Ecem Kaya Sezginer
- Faculty of Pharmacy, Department of Biochemistry, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Faculty of Pharmacy, Department of Biochemistry, Ankara University, Ankara, Turkey
| | - Utku Lokman
- Department of Urology, Ankara Occupational Diseases Hospital, Ankara, Turkey
| | - Serpil Nebioglu
- Faculty of Pharmacy, Department of Biochemistry, Ankara University, Ankara, Turkey
| | - Fugen Aktan
- Faculty of Pharmacy, Department of Biochemistry, Ankara University, Ankara, Turkey
| | - Serap Gur
- Faculty of Pharmacy, Department of Biochemistry, Ankara University, Ankara, Turkey
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15
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Sulforaphane Ameliorates Bladder Dysfunction through Activation of the Nrf2-ARE Pathway in a Rat Model of Partial Bladder Outlet Obstruction. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7598294. [PMID: 27433291 PMCID: PMC4940551 DOI: 10.1155/2016/7598294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/10/2016] [Accepted: 04/14/2016] [Indexed: 11/17/2022]
Abstract
Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO). Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway. Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins. Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction.
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16
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Sturm RM, Cheng EY. Bladder wall thickness in the assessment of neurogenic bladder: a translational discussion of current clinical applications. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:32. [PMID: 26889485 DOI: 10.3978/j.issn.2305-5839.2015.10.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The prospective trial by Kim et al. "Can Bladder Wall Thickness Predict Videourodynamic Findings in Children with Spina Bifida?" published in Journal of Urology investigated the measurement of bladder wall thickness (BWT) as a non-invasive assessment tool for lower urinary tract changes in neurogenic bladder (NGB). In this study, no significant association was observed between BWT and high-risk urodynamic parameters. This editorial discusses the basic science of bladder wall thickening as well as prior studies relating wall thickness to clinical parameters. Although Kim et al. provide a unique literature contribution in terms of assessment of BWT at defined percent cystometric capacity, specific aspects of study methodology and population may have contributed to a lack of correlation with high-risk urodynamic findings. The application of non-invasive modalities to lower urinary tract assessment of NGB remains a promising and relevant area of future research to prevent progression to end stage lower urinary tract changes for all individuals with spina bifida.
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Affiliation(s)
- Renea M Sturm
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Earl Y Cheng
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA
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17
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Magistro G, Stief CG, Gratzke C. New intraprostatic injectables and prostatic urethral lift for male LUTS. Nat Rev Urol 2015. [PMID: 26195444 DOI: 10.1038/nrurol.2015.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment modalities for male lower urinary tract symptoms (LUTS) comprise a broad spectrum of medical and surgical options. Interest is growing in minimally invasive treatment options, which should ideally be performed in an outpatient setting and have a short recovery time, durable efficacy and a good safety profile. The preservation of all aspects of sexual function, including antegrade ejaculation, seems to be increasingly important for patients. Initial experimental data on new minimally invasive procedures-such as the intraprostatic injection of novel agents including botulinum neurotoxin A (BoNT-A), NX-1207 and PRX302-were promising, but clinical trials have not confirmed the findings. Trials of the mechanical prostatic urethral lift device-Urolift(®) (Neotract, Inc., USA)-have been positive, but further long-term results are needed to confirm its beneficial effects.
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Affiliation(s)
- Giuseppe Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Gratzke
- Urologische Klinik und Poliklinik, Klinikum der Universität München-Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
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