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Taha TM, Ali MO, Shahat AA, Abdalla MA, Hammouda HM, Behnsawy HM. Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial. Int J Urol 2023; 30:922-928. [PMID: 37365775 DOI: 10.1111/iju.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To assess the efficacy of primary urethral realignment in the prevention of urethral stenosis and in simplifying delayed urethroplasty after complete pelvic fracture urethral injury in male children. METHODS This randomized comparative trial included 40 boys <18 years with complete pelvic fracture urethral injury. The initial management was a primary urethral realignment in 20 boys and suprapubic cystostomy alone in the remaining 20 boys. The boys who underwent primary urethral realignment were assessed regarding the development of urethral stenosis. Boys who needed to be delayed urethroplasty in the two groups were compared regarding urethral defect length, intraoperative details, postoperative outcomes, number of procedures, and time to achieve normal voiding. RESULTS Although 14 (70%) patients were able to void after primary urethral realignment, all of them developed urethral stenosis and needed delayed urethroplasty. No statistically significant difference between the two groups was found regarding urethral defect length, intraoperative details, and postoperative outcomes. Patients in the primary urethral realignment group underwent significantly more procedures (p < 0.001) and took a significantly longer time to achieve normal voiding (p = 0.002). CONCLUSION Primary urethral realignment is neither able to prevent urethral stenosis nor effective in simplifying later urethroplasty after complete pelvic fracture urethral injury in male children. It exposes the patients to more surgical procedures and a prolonged clinical course.
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Affiliation(s)
- Taha M Taha
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed O Ali
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Shahat
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Medhat A Abdalla
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham M Hammouda
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hosny M Behnsawy
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Moeen AM, Faragallah MA, Zarzour MA, Elbehairy AA, Behnsawy HM. Ileal conduit versus single stoma uretero-cutanoustomy after radical cystectomy in patients ≥ 75 years; which technique is better? a prospective randomized comparative study. Int Urol Nephrol 2023:10.1007/s11255-023-03609-x. [PMID: 37133765 DOI: 10.1007/s11255-023-03609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To compare the clinical results and patients' health-related quality of life (HR-QoL) of ileal conduit (IC) versus single stoma uretero-cutanoustomy (SSUC) after radical cystectomy in two groups of randomly selected patients ≥ 75 years. METHODS From January 2013 to March 2018, 100 patients ≥ 75 years with muscle invasive BCa underwent RCX and cutaneous diversion. Patients were divided in two groups; group I underwent IC (50 patients) and group II underwent SSUC (50 patients). Postoperative evaluation included clinical, laboratory, radiographic and HR-QoL. The latter was performed using the Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-BL) after 12 months postoperatively. RESULTS Patients' characteristics were comparable between both groups. No intraoperative complications occurred. Early postoperative complications occurred in 27 patients [16 (35.5%) in group I and 11 (23.9%) in group II (p = 0.02)]. Delayed postoperative complications occurred in 26 patients [6 (13.3%) in group I and 20 (43.4%) in group II, (P = 0.002)]. No significant differences between both groups regarding the physical, social/family, emotional, functional and additional concerns scales of FACT-BL questionnaire were reported. CONCLUSION SSUC is a good alternative to IC in elderly frail patients ≥ 75 years and those with multiple comorbidities who require rapid surgery in terms of perioperative complications and HR-QoL. However, the stomal complications and the possibility of a frequent stent exchange are considered its drawbacks.
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Affiliation(s)
- Ahmed M Moeen
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt.
| | | | - Mohamed A Zarzour
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Ahmed A Elbehairy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Hosny M Behnsawy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
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Moeen AM, Kamel M, Khalil M, Elanany FG, Sayed MAB, Behnsawy HM. The safety and efficacy of ultrasound versus fluoroscopic percutaneous nephrostomy: A prospective randomized study. Urol Ann 2023; 15:215-219. [PMID: 37304507 PMCID: PMC10252783 DOI: 10.4103/ua.ua_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 01/04/2023] [Indexed: 06/13/2023] Open
Abstract
Objective The objective of this study is to compare the outcome of percutaneous nephrostomy by ultrasound (US) versus fluoroscopy including access time, volume of anesthesia required, success rate, and complications. Methods One hundred patients were enrolled in a prospective randomized study. Patients were divided into two groups, 50 cases each. Comparing the two groups was done regarding the need for dye, radiation effect, time taken, trial number, rate of complication, volume of anesthesia, and success rate. Results Patient demographics were comparable between both groups with no statistically significant difference. According to the modified Clavien-Dindo classification, the complications were Grade I (pain and mild hematuria) in each group. Procedural pain was present in 41 (82%) patients in Group I and in 48 (96%) patients in Group II. It was treated in both groups with a simple analgesic. Mild hematuria was present in 5 (10%) patients in the US group and 13 (26%) in the fluoroscopic group and treated by hemostatic drugs only. There was a statistically significant difference between both groups regarding the volume of required local anesthesia, the trial numbers, the puncture numbers, bleeding, extravasation, and change in the hemoglobin level. Conclusion US percutaneous renal access is a safe and effective modality with a high success rate, less operative time, and complication rate. However, a minimum of 50 cases with some pelvicalyceal system dilation may be preliminary requisites to achieve good orientation and competence in achieving safe US percutaneous renal access for future endourological procedures.
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Affiliation(s)
- Ahmed M. Moeen
- Department of Urology, Assiut University Hospital, Assiut, Egypt
| | - Mostafa Kamel
- Department of Urology, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut University Hospital, Assiut, Egypt
| | - Fathy G. Elanany
- Department of Urology, Assiut University Hospital, Assiut, Egypt
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Mohammed SA, Hetta HF, Zahran AM, Tolba MEM, Attia RAH, Behnsawy HM, Algammal AM, Batiha GES, Mohammed AQ, Ahmad AA. T cell subsets, regulatory T, regulatory B cells and proinflammatory cytokine profile in Schistosoma haematobium associated bladder cancer: First report from Upper Egypt. PLoS Negl Trop Dis 2023; 17:e0011258. [PMID: 37068081 PMCID: PMC10109487 DOI: 10.1371/journal.pntd.0011258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The function of different populations of the immune system in bladder cancer (BCa) is well established. However, the cohesive role of the immune cell profile of schistosomal BCa at systemic and tissue levels is still lacking, especially in endemic countries. The balance hypothesized between protumorigenic and antitumor molecules determines the prognosis of tumor progression. This study aimed to investigate the frequency of T cell subsets at both blood and tumor tissue, regulatory T(Treg), regulatory B cells (Breg) and proinflammatory cytokines in S. haematobium-related BCa patients in Egypt. METHODOLOGY/PRINCIPAL FINDINGS The frequency of T cell subsets at both blood and tumor tissue, regulatory T(Treg), regulatory B cells (Breg) were studied by flow cytometry and proinflammatory cytokines by ELISA in S. haematobium-related BCa patients in Egypt. The results indicated a significant increase in the activity of T-cell populations, particularly CD3+, CD4+, and regulatory T cells (Tregs), and a decrease in cytotoxic CD8+ T cells in the patient group. An increased proportion of CD19+CD24+CD38+ Bregs and proinflammatory cytokines (IL-1β, IL-6, and TNF-α) was also observed. However, T-cell subpopulations in the tumor microenvironment showed a significant reduction in cancer patients compared to controls. Moreover, positive correlations were observed between the frequencies of Bregs and Tregs, suggesting the promotion of cancer progression besides their relation to the intensity of schistosomal infection. CONCLUSIONS/SIGNIFICANCE Trapped Schistosoma haematobium eggs in bladder tissue might lead to persistent inflammation that contributes to immunomodulation and promotes tumor progression, as evidenced by the increase in peripheral T helper, Tregs, Bregs and serum tumor-promoting cytokines. Considering the role and integrated functions of specific immune responses in BCa could help future diagnostic and therapeutic implications.
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Affiliation(s)
- Sara Abdelal Mohammed
- Department of Parasitology, Faculty of veterinary medicine, Assiut University, Assiut, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Asmaa M Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut Egypt
| | - Mohammed E M Tolba
- Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Rasha A H Attia
- Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hosny M Behnsawy
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelazeem M Algammal
- Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicines, Damanhour University, Damanhour, Egypt
| | - Ahmed Qasem Mohammed
- Department of Gastroenterology, Hepatology and infectious diseases, Al-Azhar University, Assuit, Egypt
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Moeen AM, Behnsawy HM, Faragallah MA, Gadelkareem RA, Osman MM, Moeen SM, Hameed DA, Zarzour MA. Functional evaluation of a spiral neobladder with an angled chimney; A prospective randomized comparative study. Eur J Surg Oncol 2023; 49:491-496. [PMID: 36244843 DOI: 10.1016/j.ejso.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES to assess the functional outcome of performing ureteric re-implantation to an angled short chimney in a modified spiral orthotopic ileal neobladder. PATIENTS AND METHODS From January 2018 to December 2020, 90 male patients with bladder cancer underwent radical cystectomy and spiral ileal neobladder reconstruction with a chimney. Patients were randomly divided in two groups according to the position of the chimney [straight and angled] to which the ureters will be implanted. Postoperative evaluation included clinical, laboratory, radiographic and urodynamic studies. RESULTS There were no perioperative deaths. The mean operative time for the procedure was 4.7 ± 1.2 h in group I and 4.9 ± 1.3 h in group II (p 0.456). No intraoperative complications occurred. Early postoperative complications occurred in 8 patients. In group I, according to the modified Clavien system, GII complication occurred in 2 (5%) patients in the form of DVT in 1 (2.5%) and surgical site infection in 1 (2.5%). GIIIa occurred in 3 (7.5%) patients in the form of wound dehiscence. In group II, GII occurred in 2 (4.8%) patients in the form of prolonged urinary leakage and myocardial infarction, each occurred in one patient. GIIIb occurred in 1 (2.4%) patient in the form of intestinal leak. Poucho-ureteral reflux occurred in 10 patients [3 (7.5%) in group I and 7 (16.8%) in group II (p 0.001)]. CONCLUSIONS The preliminary results of the right sided angled chimney during neobladder reconstruction are safe, acceptable, without an extra time to develop an anti-reflux technique and without an increased incidence of reflux.
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Affiliation(s)
- Ahmed M Moeen
- Department of Urology, Assiut University, Asyut, Egypt.
| | | | | | | | | | - Seham M Moeen
- Department of Anesthesia and Intensive Care Unit, Assiut University, Asyut, Egypt
| | - Diaa A Hameed
- Department of Urology, Assiut University, Asyut, Egypt
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Elderwy AA, Gadelmoula M, Elgammal MA, Hameed DA, Behnsawy HM, Osman MM, Kurkar A. Primary versus deferred ureteroscopy for management of calculus anuria: a prospective randomized study. Cent European J Urol 2019; 71:462-466. [PMID: 30680242 PMCID: PMC6338810 DOI: 10.5173/ceju.2018.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/11/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Obstructive anuria can be managed by primary ureteroscopy (URS) or deferred URS after initial ureteral stenting. We want to compare the primary URS and deferred URS in the management of calculus anuria regarding the feasibility and clinical outcome. Material and methods Between January 2012 and December 2014, 150 patients with anuria due to ureteral calculi were prospectively randomized according to the timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting) and primary URS group (81 patients who were treated by emergency URS). Follow-up was at least 6 months postoperatively. Results Complete stone clearance was 87 % and 75.3% for deferred and primary URS groups, respectively (p = 0.097). Renal function normalized in 94.2% of deferred URS vs. 97.5% of primary URS (p = 0.414). Deferred URS group had a 2.9 % overall complication rate in comparison to 9.9 % for the primary URS group (p = 0.109). Ureteral perforation/pyelonephritis was noted in 6.2% of the primary URS group only (p = 0.043). The median number of maneuvers required until stone clearance was one (range 1–5) for primary URS vs. two (range 2–3) for deferred URS (p <0.001). The cost of primary URS was significantly less (p <0.001). On a multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.07– 41.7, p <0.001) and deferred URS (OR 2.84, 95% CI 1.07–7.49, p = 0.035) were independent predictors for an eventless and successful URS. Conclusions Primary URS for calculus anuria is feasible and cost-effective. It has a short hospital stay, but is still technically demanding. The perioperative complications are comparable to URS in normouric patients.
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Affiliation(s)
- Ahmad A Elderwy
- Assiut University, Urology and Nephrology Hospital, Assiut, Egypt
| | | | | | - Diaa A Hameed
- Assiut University, Urology and Nephrology Hospital, Assiut, Egypt
| | - Hosny M Behnsawy
- Assiut University, Urology and Nephrology Hospital, Assiut, Egypt
| | - Mahmoud M Osman
- Assiut University, Urology and Nephrology Hospital, Assiut, Egypt
| | - Adel Kurkar
- Assiut University, Urology and Nephrology Hospital, Assiut, Egypt
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Moeen AM, Safwat AS, Gadelmoula MM, Moeen SM, Behnsawy HM, Shahat AA, Gadelkareem RA, Hameed DA, Hammouda HM. Does the site of the orthotopic neobladder outlet matter? A prospective randomized comparative study. Eur J Surg Oncol 2018; 44:847-852. [PMID: 29429598 DOI: 10.1016/j.ejso.2018.01.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. METHODS From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. RESULTS There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). CONCLUSION The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.
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Affiliation(s)
- Ahmed M Moeen
- Department of Urology, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | | | - Seham M Moeen
- Department of Anesthesiology and Intensive Care, Assiut University, Assiut, Egypt
| | | | | | | | - Diaa A Hameed
- Department of Urology, Assiut University, Assiut, Egypt
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Abstract
OBJECTIVE The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.
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Affiliation(s)
- Ahmed M Moeen
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmed S Safwat
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmad A Elderwy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Hosny M Behnsawy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Mahmoud M Osman
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Diaa A Hameed
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
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Elgammal MA, Elderwy AA, Gadelmoula MM, Hameed DA, Behnsawy HM, Osman MM, Kurkar A. MP51-09 PRIMARY VERSUS DEFERRED URETEROSCOPY FOR MANAGEMENT OF CALCULUS ANURIA: A PROSPECTIVE RANDOMIZED TRIAL. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamamichi F, Shigemura K, Behnsawy HM, Yamashita M, Shirakawa T, Fujisawa M. Beta-3 adrenergic receptors could be significant factors for overactive bladder-related symptoms. Int J Clin Exp Pathol 2015; 8:11863-70. [PMID: 26617941 PMCID: PMC4637757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/23/2015] [Indexed: 06/05/2023]
Abstract
The treatment failure often happens in overactive bladder (OAB) partly owing to its unknown pathogenesis. The purpose of this study is to find significant receptors or biological markers for OAB-related symptoms for establishment of potential order-made therapeutic strategies. The overactive bladder symptom scores (OABSS) and international prostate symptom scores (IPSS)/quality of life (QOL) were questioned in all the 18 patients with OAB diagnosis. Their bladder mucosal tissues were taken from the random biopsy of bladder cancer suspected patients without any finding such as inflammation or carcinoma in situ. They were investigated quantitatively by immunohistochemical (IHC) stainings for inflammatory or immune-system (Interleukin (IL)-6 and cyclooxygenase-2 (Cox-2)), Caspase-3 apoptosis markers, angiogenesis (CD-31), epithelial-mesenchymal transition (E-cadherin) and muscarinic receptor (Muscarine-2 (M)-2), adrenergic receptors (ARs) (alpha 1-d (α1-d) and beta-3 (β-3)). The statistical correlation between the expressions of these 5 markers and 3 receptors and these symptom scores were examined under the comparison between OAB patients and control patients who had urgency score with less than 2 in OABSS. The OABSS and IPSS/QOL was 7.39 ± 2.69 and 21.2 ± 6.59/4.33 ± 1.33, respectively but those of control patients were 2.00 ± 1.41 and 10.1 ± 9.52/2.14 ± 1.46, respectively (P<0.05). Regarding the correlation of those markers' expressions and symptom scores, in OAB patients, OABSS total significantly correlated with β-3 AR expressions (P=0.0457). IPSS post-voiding significantly correlated with β-3 AR expressions (P=0.0308) but no significant relationship in control patients (P>0.05). In conclusion, this study demonstrated that β-3 AR in our tested 8 markers or receptors was correlated strongly with OAB-related symptoms. These data may help elucidate the pathophysiology of OAB and offer possible strategy for its order-made therapies.
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Affiliation(s)
- Fukashi Yamamichi
- Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
- Department of Urology, Hyogo Prefectural Amagasaki General Medical Center2-17-77 Higashi Naniwa-cho, Amagasaki 660-8550, Japan
| | - Katsumi Shigemura
- Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Hosny M Behnsawy
- Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
- Department of Urology, Assiut Urology and Nephrology Center, Faculty of Medicine, Assiut UniversityAssiut, Egypt
| | - Masuo Yamashita
- Department of Urology, Shinko Hospital1-4-47 Wakihama-cho, Chuo-ku, Kobe 651-0072, Japan
| | - Toshiro Shirakawa
- Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Masato Fujisawa
- Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
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Nishikawa M, Miyake H, Behnsawy HM, Fujisawa M. Significance of 4E-binding protein 1 as a therapeutic target for invasive urothelial carcinoma of the bladder. Urol Oncol 2015; 33:166.e9-15. [PMID: 25618298 DOI: 10.1016/j.urolonc.2014.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND To evaluate the expression of multiple molecular markers involved in the mammalian target of rapamycin (mTOR) signaling pathway in human muscle-invasive bladder cancer (BC) and to assess the therapeutic efficacies of mTOR inhibitors in human BC KoTCC-1 cells. METHODS Expression levels of 5 markers, including PTEN, phosphorylated (p)-Akt, p-mTOR, p-p70 ribosomal S6 kinase, and p-4E-binding protein 1 (4E-BP1), were measured in radical cystectomy specimens from 49 patients with muscle-invasive BC by immunohistochemical staining. We then analyzed the effects of treatment with temsirolimus or Ku-0063794, a dual inhibitor of mTOR complex 1 (C1) and mTOR complex 2 (C2), on changes in the growth and expression profiles of 5 mTOR-associated markers in KoTCC-1 cells. RESULTS During the follow-up period of this study, disease recurred in 27 patients (55.1%), and of several factors examined, the expression level of p-4E-BP1 in addition to the pathological T stage was independently related to recurrence-free survival on multivariate analysis. Although the growth of KoTCC-1 cells was inhibited by both temsirolimus and Ku-0063794 in dose-dependent manners, treatment with Ku-0063794 resulted in a marked decrease in the expression of p-4E-BP1 in KoTCC-1 cells compared with that with temsirolimus. Furthermore, the growth-inhibitory effect of both mTOR inhibitors was shown to be proportional to the expression levels of p-4E-BP1. CONCLUSIONS The phosphorylation status of 4E-BP1 appeared to be correlated with the prognosis of patients with muscle-invasive BC following radical cystectomy as well as the sensitivities of BC cells to mTOR inhibitors; therefore, the inactivation of 4E-BP1 using Ku-0063794 may be a promising novel approach for muscle-invasive BC.
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Affiliation(s)
- Masatomo Nishikawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Hosny M Behnsawy
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Miyake H, Behnsawy HM, Hinata N, Fujisawa M. Objective Assessment of Residual Nerve Tissues in Radical Prostatectomy Specimens by Immunohistochemical Staining of Neuronal Nitric Oxide Synthase–positive Nerves and Its Impact on Postoperative Erectile Function. Urology 2014; 84:1395-401. [DOI: 10.1016/j.urology.2014.05.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 10/24/2022]
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Yamamichi F, Shigemura K, Behnsawy HM, Meligy FY, Huang WC, Li X, Yamanaka K, Hanioka K, Miyake H, Tanaka K, Kawabata M, Shirakawa T, Fujisawa M. Sonic hedgehog and androgen signaling in tumor and stromal compartments drives epithelial-mesenchymal transition in prostate cancer. Scand J Urol 2014; 48:523-32. [PMID: 25356787 DOI: 10.3109/21681805.2014.898336] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Sonic hedgehog (Shh) signaling, androgens and epithelial-mesenchymal transition (EMT) are related to prostate cancer (PCa) progression. The aim of this study was to investigate how Shh and androgen [dihydrotestosterone (DHT)] signaling act in prostate epithelial and stromal compartments and whether this signaling pathway drives EMT and promotes PCa progression. MATERIAL AND METHODS LNCaP, normal prostate fibroblast (NPF) and cancer-associated prostate fibroblast (CPF) cells were studied with DHT and/or the Shh signaling inhibitor cyclopamine. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed to evaluate the expressions of a potential Shh target gene, osteonectin (ON) and EMT-associated markers (E-cadherin, N-cadherin and vimentin). Immunohistochemical studies using PCa prostatectomy samples were performed to assess the expression levels of ON, Gli-1, androgen receptor, Shh, E-cadherin, N-cadherin and vimentin. RESULTS While DHT enhanced cell proliferation in CPF more than LNCaP or NPF, cyclopamine inhibited cell proliferation enhanced by DHT in CPF. Real-time RT-PCR showed whereas both Shh and DHT induced N-cadherin and vimentin, DHT also induced the expression of osteonectin in LNCaP and cyclopamine blocked these expressions in osteonectin, N-cadherin and vimentin (p = 0.0084, 0.0002 and 0.0373, respectively). Immunohistochemistry showed that high expression of stromal, but, not epithelial, ON was significantly correlated with serum prostate-specific antigen (PSA) (p = 0.031), and high expression of Gli-1 and low expression of stromal ON with PSA recurrence (p = 0.0114 and p = 0.0005, respectively). CONCLUSIONS Shh and androgen signaling in prostate tumor and stromal compartments drives EMT, and thus may play some role in PCa progression. Cyclopamine may be one therapeutic strategy for PCa.
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Affiliation(s)
- Fukashi Yamamichi
- Department of Urology, Kobe University Graduate School of Medicine , Kobe , Japan
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Ko YH, Miyake H, Behnsawy HM, Cheon J, Fujisawa M. Limited significance of activated Akt-mammalian target of rapamycin signaling pathway in prostate cancer progression. Urol Int 2014; 93:146-51. [PMID: 24556942 DOI: 10.1159/000356262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the significance of the activated Akt-mammalian target of rapamycin (Akt-mTOR) signaling pathway in the progression of prostate cancer. MATERIALS AND METHODS The expression levels of Akt, phosphorylated Akt (p-Akt), mTOR and phosphorylated mTOR (p-mTOR) in 175 prostate specimens, including 61 normal prostate tissues as a control, 24 high-grade prostatic intraepithelial neoplasias (HGPINs) and 90 clinically localized prostate cancers, were evaluated by immunohistochemical staining. p-Akt and p-mTOR ratios, which were defined as the expression level of p-Akt in relation to that of Akt and the expression level of p-mTOR in relation to that of mTOR, respectively, in these specimens were calculated. RESULTS Expression levels of all four molecules, including Akt, p-Akt, mTOR and p-mTOR, were significantly greater in the HGPIN group compared with the normal control and prostate cancer groups. Furthermore, the p-Akt ratio in the prostate cancer group was significantly lower than that in the HGPIN group, while there was no significant difference in the p-mTOR ratio between the HGPIN and prostate cancer groups. In the prostate cancer group, no significant relationships were observed between major clinicopathological parameters and the expression levels as well as the ratios of p-Akt or p-mTOR. CONCLUSIONS The Akt-mTOR signaling pathway may play a limited role in the progression of prostate cancer.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Muramaki M, Miyake H, Behnsawy HM, Furukawa J, Harada KI, Fujisawa M. Assessment of postoperative quality of life: comparative study between laparoscopic and minimum incision endoscopic radical prostatectomies. Int J Clin Oncol 2013; 19:1092-7. [PMID: 24370729 DOI: 10.1007/s10147-013-0659-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/12/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND To investigate the changes in postoperative quality of life (QOL) in patients with prostate cancer who underwent laparoscopic radical prostatectomy (LRP) or minimum incision endoscopic radical prostatectomy (MIE-RP). METHODS This study included a total of 115 Japanese patients with clinically localized prostate cancer who underwent either LRP or MIE-RP and were subsequently followed for more than 12 months. Before and 12 months after surgery, health-related QOL and disease-specific QOL were assessed using the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) and the Expanded Prostate Index Composite (EPIC), respectively. RESULTS LRP and MIE-RP were performed in 57 and 58 patients, respectively, and there were no significant differences in major clinicopathological parameters between these two groups. There were no significant differences in perioperative outcomes between the two groups except for the estimated blood loss, which was lower in the LRP group. There were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the SF-8 survey. Of the fourteen scores evaluated by the EPIC survey, postoperative scores for urinary summary, sexual summary, urinary function, urinary incontinence and sexual function were significantly worse than these preoperative scores in both LRP and MIE-RP groups, while there were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the EPIC survey. CONCLUSIONS The postoperative QOL status in patients undergoing MIE-RP appeared to be equivalent to that in those undergoing LRP.
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Affiliation(s)
- Mototsugu Muramaki
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kumano M, Miyake H, Abolghait SK, Behnsawy HM, Fujisawa M. β4-integrin-mediated cytotoxic activity of AexU in human prostate cancer PC3 cells. Oncol Lett 2013; 6:1482-1486. [PMID: 24179545 PMCID: PMC3813740 DOI: 10.3892/ol.2013.1542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 08/02/2013] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to characterize the cytotoxic activity of AexU, an effector-mediating type three secretion system (TTSS) of gram-negative bacteria, in human prostate cancer cells, focusing on the association with β4-integrin expression. The cytotoxic effects of AexU either alone or in combination with chemotherapeutic agents were evaluated using several human prostate cancer cell lines. Human prostate cancer PC3 cells, in which an expression vector containing siRNA targeting β4-integrin had been introduced, were established (PC3/sh-In), and the cytotoxic effects of AexU on the PC3/sh-In cells were compared with the PC3 cells that were transfected with a control vector (PC3/C). The expression levels of β4-integrin in the PC3 cells were markedly higher compared with those in the LNCaP or DU145 cells, and the cytotoxic effects of AexU in the PC3 cells were more pronounced compared with those in the LNCaP or DU145 cells. The sensitivity of the PC3 cells to docetaxel and cisplatin was significantly enhanced following treatment with AexU, resulting in a decrease in the IC50 of the two agents by ~90%. The cytotoxic effect of AexU in the PC3/C cells was more marked compared with that in the PC3/sh-In cells, and the phosphorylation of Akt in the PC3/C cells appeared to be significantly more inhibited by the treatment with AexU compared with the PC3/sh-In cells. In conclusion, treatment with AexU may be a useful therapeutic option for prostate cancer when β4-integrin is overexpressed. The treatment appears to exert its effects through growth inhibition and by enhancing the sensitivity of the cancer cells to chemotherapeutic agents.
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Affiliation(s)
- Masafumi Kumano
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Behnsawy HM, Shigemura K, Meligy FY, Yamamichi F, Yamashita M, Haung WC, Li X, Miyake H, Tanaka K, Kawabata M, Shirakawa T, Fujisawa M. Possible role of sonic hedgehog and epithelial-mesenchymal transition in renal cell cancer progression. Korean J Urol 2013; 54:547-54. [PMID: 23956832 PMCID: PMC3742909 DOI: 10.4111/kju.2013.54.8.547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/06/2013] [Indexed: 11/24/2022] Open
Abstract
Purpose Sonic hedgehog (Shh) signaling and epithelial-mesenchymal transition (EMT) are both known to relate to cancer progression. The purpose of this study was to investigate the role of Shh signaling and EMT in renal cell carcinoma (RCC). Materials and Methods Cell proliferation was assayed in RCC cell lines in the presence or absence of a Shh signaling stimulator, recombinant Shh (r-Shh) protein, or a Shh signaling inhibitor, cyclopamine. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed to study the expression of EMT markers (E-cadherin, N-cadherin, and vimentin) and osteonectin. The expression of Ki-67, Gli-1, osteonectin, and EMT markers in nephrectomy specimens from RCC patients was also measured by immunohistochemical (IHC) staining. Results RCC cells showed enhanced cell proliferation by r-Shh protein, whereas cell proliferation was suppressed by the addition of cyclopamine in RenCa cells. Real-time RT-PCR showed that r-Shh suppressed the expression of E-cadherin and that this suppression was partly blocked by cyclopamine alone in RenCa cells. In the IHC results, osteonectin significantly correlated with vein sinus invasion (p=0.0218), and the expression of vimentin significantly correlated with lymphatic invasion (p=0.0392). Conclusions Shh signaling and EMT play roles in RCC progression, and the Shh signaling inhibitor cyclopamine might be a possible molecular targeted therapeutic strategy for RCC.
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Affiliation(s)
- Hosny M Behnsawy
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. ; Faculty of Medicine, Assiut University, Assiut, Egypt
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Behnsawy HM, Miyake H, Harada KI, Fujisawa M. Expression patterns of epithelial-mesenchymal transition markers in localized prostate cancer: significance in clinicopathological outcomes following radical prostatectomy. BJU Int 2012; 111:30-7. [PMID: 23107154 DOI: 10.1111/j.1464-410x.2012.11551.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the expression patterns of multiple molecular markers implicated in epithelial-mesenchymal transition (EMT) in localized prostate cancer (PC), in order to clarify the significance of these markers in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS Expression levels of 13 EMT markers, namely E-cadherin, N-cadherin, β-catenin, γ-catenin, fibronectin, matrix metalloproteinase (MMP) 2, MMP-9, Slug, Snail, Twist, vimentin, ZEB1 and ZEB2, in RP specimens from 197 consecutive patients with localized PC were evaluated by immunohistochemical staining. RESULTS Of the 13 markers, expression levels of E-cadherin, Snail, Twist and vimentin were closely associated with several conventional prognostic factors. Univariate analysis identified these four EMT markers as significant predictors for biochemical recurrence (BR), while serum prostate-specific antigen, Gleason score, seminal vesicle invasion (SVI), surgical margin status (SMS) and tumour volume were also significant. Of these significant factors, expression levels of Twist and vimentin, SVI and SMS appeared to be independently related to BR on multivariate analysis. There were significant differences in BR-free survival according to positive numbers of these four independent factors. That is, BR occurred in four of 90 patients who were negative for risk factors (4.4%), 21 of 83 positive for one or two risk factors (25.3%) and 19 of 24 positive for three or four risk factors (79.2%). CONCLUSION Measurement of expression levels of potential EMT markers, particularly Twist and vimentin, in RP specimens, in addition to conventional prognostic parameters, would contribute to the accurate prediction of the biochemical outcome in patients with localized PC following RP.
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Affiliation(s)
- Hosny M Behnsawy
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Behnsawy HM, Miyake H, Kusuda Y, Fujisawa M. Small interfering RNA targeting heat shock protein 70 enhances chemosensitivity in human bladder cancer cells. Urol Oncol 2011; 31:843-8. [PMID: 21889367 DOI: 10.1016/j.urolonc.2011.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 06/25/2011] [Accepted: 07/11/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the expression levels of heat shock protein 70 (HSP70) in human urothelial cancer of the bladder and to assess the therapeutic effects of treatment with small interfering RNA (siRNA) targeting HSP70 on human bladder cancer KoTCC-1 cells. MATERIALS AND METHODS HSP70 expression in bladder cancer specimens obtained from 235 patients were evaluated by immunohistochemical staining. We then analyzed changes in the growth and chemosensitivity of KoTCC-1 cells following treatment with HSP70 siRNA. RESULTS Expression levels of HSP70 protein in bladder cancer specimens were significantly related to major prognostic indicators, including pathologic stage and tumor grade. Treatment of KoTCC-1 with HSP70 siRNA resulted in a dose-dependent inhibition of HSP70 expression. HSP70 siRNA significantly inhibited the growth of KoTCC-1 compared with that after treatment with scrambled control siRNA. Among several chemotherapeutic agents, the most powerful synergistic cytotoxic effect was observed when KoTCC-1 was treated with gemcitabine plus HSP70 siRNA, which induced more than 50% reduction in the IC50 of gemcitabine. Furthermore, a significant increase in the subG0-G1 fraction of KoTCC-1 and the DNA fragmentation was observed only after combined treatment with HSP70 siRNA and sublethal doses of gemcitabine, but not after treatment with either agent alone. Similarly, caspase-3 and caspase-9, but not caspase-8, in KoTCC-1 were synergistically activated by combined treatment with gemcitabine and HSP70 siRNA. CONCLUSIONS Silencing of HSP70 expression using siRNA could be an attractive therapeutic strategy for bladder cancer by inducing inhibition of tumor growth as well as enhancing chemosensitivity.
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Affiliation(s)
- Hosny M Behnsawy
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Kusuda Y, Miyake H, Behnsawy HM, Fukuhara T, Inoue TA, Fujisawa M. Prognostic prediction in patients with metastatic renal cell carcinoma treated with sorafenib based on expression levels of potential molecular markers in radical nephrectomy specimens. Urol Oncol 2011; 31:42-50. [PMID: 21396851 DOI: 10.1016/j.urolonc.2010.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the expression levels of multiple molecular markers in radical nephrectomy specimens from patients with metastatic renal cell carcinoma (RCC) treated with sorafenib in order to identify factors predicting susceptibility to this agent. MATERIALS AND METHODS This study included 45 consecutive patients undergoing radical nephrectomy for clear cell RCC who were diagnosed as having metastatic diseases refractory to cytokine therapy and subsequently treated with sorafenib. Expression levels of 19 molecular markers involved in the regulation of apoptosis, cell cycle, signal transduction, and angiogenesis in primary RCC specimens were measured by immunohistochemical staining. RESULTS There was no molecular marker having significant impact on the prediction of response to sorafenib. However, progression-free survival (PFS) was significantly associated with the expression levels of Bcl-xL and platelet-derived growth factor receptor (PDGFR)-α in addition to the presence of bone metastasis and C-reactive protein level on univariate analysis. Of these significant factors, PDGFR-α expression and the presence of bone metastasis appeared to be independently related to PFS by multivariate analysis. Furthermore, there were significant differences in PFS according to positive numbers of these 2 independent risk factors; that is, disease progression occurred in 2 of 7 patients who were negative for risk factor, 19 of 34 positive for a single risk factor, and 6 of 6 positive for both risk factors. CONCLUSIONS Collectively, these findings suggest that it would be useful to consider expression levels of potential molecular markers, particularly PDGFR-α, as well as clinical parameters to select metastatic RCC patients likely to benefit from treatment with sorafenib.
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Affiliation(s)
- Yuji Kusuda
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Behnsawy HM, Miyake H, Abdalla MA, Sayed MA, Ahmed AEFI, Fujisawa M. Expression of integrin proteins in non-muscle-invasive bladder cancer: significance of intravesical recurrence after transurethral resection. BJU Int 2010; 107:240-6. [DOI: 10.1111/j.1464-410x.2010.09534.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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