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Wang L, Sun W, Ren G, Sun Y, Xu C, Song Q, Zhang X, Yang C, Liu Z. Deletion of Nrf2 induced severe oxidative stress and apoptosis in mice model of diabetic bladder dysfunction. Int Urol Nephrol 2024:10.1007/s11255-024-04064-y. [PMID: 38771415 DOI: 10.1007/s11255-024-04064-y] [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: 03/17/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
The nuclear factor erythroid 2-related factor 2 (Nrf2) pathway has been confirmed as a therapeutic target for type 2 diabetes mellitus (T2DM), however few studies revealed its effect in diabetic bladder dysfunction (DBD). Herein, we reported a Nrf2 deletion diabetic mouse model induced by 8-week high-fat diet feeding combined with streptozocin (STZ) injection in Nrf2 knockout mice. Besides, wild-type mice (WT) were used as control group, wild-type mice with high-fat diet feeding and STZ injection as diabetic group (WT-T2DM), and Nrf2 knockout mice as Nrf2 deletion group (KO). The pathophysiological indexes and bladder morphology showed typical pathological features of diabetic bladder dysfunction in Nrf2 knockout diabetic mouse mice (KO-T2DM). ELISA results showed that advanced glycation end products (AGEs), ROS and malondialdehyde (MDA) levels in bladder was were up-regulated in both WT-T2DM and KO-T2DM group, while superoxide dismutase (SOD) and glutathione (GSH) levels decreased in these two groups. Compared with WT-T2DM group, western blot analysis of the bladder showed down-regulated expression of NQO1 and HO-1 in KO-T2DM group. However, apoptosis, marked by Caspase3 and bax/bcl-2 ratio, was increased in KO-T2DM group. Neurotrophic factor (NGF) was significantly decreased in DBD model, and even much lower in KO-T2DM group. Collectively, our findings demonstrated that deletion of Nrf2 lead to severe oxidative stress, apoptosis, and lower level of neurotrophic factor, and provided the first set of experimental evidence, in a mouse model, to support Nrf2 as a promising target for DBD.
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Affiliation(s)
- Lei Wang
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Weiaho Sun
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Guanyu Ren
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Yi Sun
- Department of Pharmacology, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Cheng Xu
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Qixiang Song
- Department of Urology Surgery, Renji Hospital, ShangHai JiaoTong University, Shanghai, 200433, China
| | - Xinhui Zhang
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Chenghua Yang
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Zhiyong Liu
- Department of Urology Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China.
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Oliveira AL, de Oliveira MG, Mónica FZ, Antunes E. Methylglyoxal and Advanced Glycation End Products (AGEs): Targets for the Prevention and Treatment of Diabetes-Associated Bladder Dysfunction? Biomedicines 2024; 12:939. [PMID: 38790901 PMCID: PMC11118115 DOI: 10.3390/biomedicines12050939] [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: 03/19/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
Methylglyoxal (MGO) is a highly reactive α-dicarbonyl compound formed endogenously from 3-carbon glycolytic intermediates. Methylglyoxal accumulated in plasma and urine of hyperglycemic and diabetic individuals acts as a potent peptide glycation molecule, giving rise to advanced glycation end products (AGEs) like arginine-derived hydroimidazolone (MG-H1) and carboxyethyl-lysine (CEL). Methylglyoxal-derived AGEs exert their effects mostly via activation of RAGE, a cell surface receptor that initiates multiple intracellular signaling pathways, favoring a pro-oxidant environment through NADPH oxidase activation and generation of high levels of reactive oxygen species (ROS). Diabetic bladder dysfunction is a bothersome urological complication in patients with poorly controlled diabetes mellitus and may comprise overactive bladder, urge incontinence, poor emptying, dribbling, incomplete emptying of the bladder, and urinary retention. Preclinical models of type 1 and type 2 diabetes have further confirmed the relationship between diabetes and voiding dysfunction. Interestingly, healthy mice supplemented with MGO for prolonged periods exhibit in vivo and in vitro bladder dysfunction, which is accompanied by increased AGE formation and RAGE expression, as well as by ROS overproduction in bladder tissues. Drugs reported to scavenge MGO and to inactivate AGEs like metformin, polyphenols, and alagebrium (ALT-711) have shown favorable outcomes on bladder dysfunction in diabetic obese leptin-deficient and MGO-exposed mice. Therefore, MGO, AGEs, and RAGE levels may be critically involved in the pathogenesis of bladder dysfunction in diabetic individuals. However, there are no clinical trials designed to test drugs that selectively inhibit the MGO-AGEs-RAGE signaling, aiming to reduce the manifestations of diabetes-associated bladder dysfunction. This review summarizes the current literature on the role of MGO-AGEs-RAGE-ROS axis in diabetes-associated bladder dysfunction. Drugs that directly inactivate MGO and ameliorate bladder dysfunction are also reviewed here.
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Affiliation(s)
| | | | | | - Edson Antunes
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13084-971, SP, Brazil; (A.L.O.); (M.G.d.O.); (F.Z.M.)
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Lee WC, Chow PM, Hsu CN, Chuang YC. The impact of diabetes on overactive bladder presentations and associations with health-seeking behavior in China, South Korea, and Taiwan: Results from a cross-sectional, population-based study. J Chin Med Assoc 2024; 87:196-201. [PMID: 38132568 DOI: 10.1097/jcma.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to explore the impact of diabetes on overactive bladder (OAB) presentations and related predictors of healthcare-seeking behavior among adults aged ≥ 40 years in China, Taiwan, and South Korea. METHODS An internet-based survey was conducted to assess the prevalence of diabetes, OAB presentations, and self-perceived urinary symptoms by a multi-national sample of 8284 individuals who completed the survey between June 2, 2015 and July 31, 2015. Independent associations with health-seeking behavior for urinary symptoms were estimated with odds ratio (OR) with 95% confidence interval (95% CI) using multivariate logistic regression. RESULTS Diabetes was reported in 13.6% of participants and OAB was 20.8%. Diabetic participants were older than non-diabetic participants in both sexes. Participants with diabetes reported a higher rate of OAB (43.1%) and increased bothersome symptoms associated with OAB than those without diabetes. Participants with diabetes (OR, 3.07 [2.39-3.96]], urgent incontinence (OR, 2.38 [1.86-3.03]), frequency (OR, 1.86 [1.45-2.38]), and nocturia (OR, 1.14 [1.05-1.24]) were associated with healthcare-seeking behavior. CONCLUSION The proportion of diabetic participants with OAB was 2.5-fold higher than those without diabetes. Diabetes, urinary frequency, nocturia, and urgent incontinence are predictors of medical treatment-seeking behavior, but the key symptom of OAB-urgency is not a predictor of treatment-seeking behavior. It is important for clinicians to recognize the interplay between diabetes and OAB and to early identify various bothersome urinary symptoms for better health outcomes in daily practice.
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Affiliation(s)
- Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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França DCH, Honorio-França AC, Silva KMR, Alves FCB, Bueno G, Costa SMB, Cotrim ACDM, Barbosa AMP, França EL, Rudge MVC, The Diamater Study Group. Serotonin and Interleukin 10 Can Influence the Blood and Urine Viscosity in Gestational Diabetes Mellitus and Pregnancy-Specific Urinary Incontinence. Int J Mol Sci 2023; 24:17125. [PMID: 38138954 PMCID: PMC10742662 DOI: 10.3390/ijms242417125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023] Open
Abstract
Serotonin and interleukin 10 (IL-10) may play a role in gestational diabetes mellitus. Hyperglycemic environment, the detrusor musculature of the bladder and pelvic floor muscles may become damaged, leading to urination problems and urine viscosity in pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. Urine and blood samples were collected from pregnant women between 24 and 28 weeks of gestation. The serotonin concentration and cytokine IL-10 levels were evaluated in plasma and urine. In the total blood and urine, the viscosity was evaluated in the presence and absence of exogenous serotonin and IL-10. The plasma serotonin levels decreased, while the urine serotonin levels increased in the normoglycemic incontinent (NG-I), hyperglycemic continent (GDM-C), and hyperglycemic incontinent (GDM-I) groups. The IL-10 in the plasma decreased in the GDM-I group and was higher in the urine in the NG-I and GDM-I groups. The blood viscosity was higher, independently of urinary incontinence, in the GDM groups. The serotonin increased the blood viscosity from women with GDM-C and urine in the NG-I, GDM-C, and GDM-I groups. Blood and urine in the presence of IL-10 showed a similar viscosity in all groups studied. Also, no difference was observed in the viscosity in either the blood or urine when in the presence of serotonin and IL-10. These findings suggest that serotonin and IL-10 have the potential to reduce blood viscosity in pregnant women with gestational diabetes and specific urinary incontinence, maintaining values similar to those in normoglycemic women's blood.
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Affiliation(s)
- Danielle Cristina Honório França
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Adenilda Cristina Honorio-França
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Kênia Maria Rezende Silva
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Fernanda Cristina Bérgamo Alves
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Gabriela Bueno
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Aron Carlos de Melo Cotrim
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marilia 17525-900, SP, Brazil
| | - Eduardo Luzía França
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - The Diamater Study Group
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
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Hennenberg M, Michel MC. Adrenoceptors in the Lower Urinary Tract. Handb Exp Pharmacol 2023. [PMID: 37455288 DOI: 10.1007/164_2023_678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Adrenoceptors importantly contribute to the physiological regulation of lower urinary tract (LUT) function and have become a target of several clinically successful treatments for major LUT diseases. In the bladder dome, β-adrenoceptor subtypes are found in multiple cell types and mediate relaxation of detrusor smooth muscle, perhaps partly indirectly by acting on afferent nerves and cells of the mucosa. β3-adrenoceptor agonists such as mirabegron and vibegron are used to treat overactive bladder syndrome. In the bladder trigone and urethra, α1-adrenoceptors cause contraction and thereby physiologically contribute to bladder outlet resistance. α1-adrenoceptors in the prostate also cause contraction and pathophysiologically elevate bladder outlet resistance leading to voiding dysfunction in benign prostatic hyperplasia. α1-adrenoceptor antagonist such as tamsulosin is widely used as a first-line option to treat LUT symptoms in men, but it remains unclear to which extent and how smooth muscle relaxation contributes to symptom relief.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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Müderrisoglu AE, Sakul AA, Murgas S, de la Rosette JJMCH, Michel MC. Association of diabetes, hypertension, and their combination with basal symptoms and treatment responses in overactive bladder patients. Front Pharmacol 2023; 14:1144470. [PMID: 37063295 PMCID: PMC10097919 DOI: 10.3389/fphar.2023.1144470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
Introduction: Pelvic hypoperfusion caused by atherosclerosis has been proposed as a cause of lower urinary tract dysfunction including overactive bladder syndrome (OAB). Limited data indicate that OAB patients with concomitant diabetes or hypertension, known risk factors of atherosclerosis, may exhibit greater baseline OAB symptoms and slightly smaller therapeutic responses to treatment, but the impact of a combined presence of diabetes and hypertension has not been reported. Therefore, we have explored whether the combined presence of both comorbidities is associated with greater baseline OAB symptoms than that of either comorbidity alone. Secondary questions were exploration of the impact of either comorbidity on baseline symptoms, and of the impact of either comorbidity alone and their combination on therapeutic responses.Methods: Data from two non-interventional studies applying treatment with propiverine ER 30 or 45 mg/d for 12 weeks were analyzed.Results: Number of urgency episodes in the combination group was greater than with each comorbidity alone. The impact of comorbidities on baseline intensity of incontinence, frequency or nocturia or Patient Perception of Bladder Condition was less consistent or absent. Either comorbidity alone was associated with a smaller % improvement of symptoms, and their combination had a greater effect than either alone. However, all attenuations associated with comorbidity were small relative to the overall improvement. Conclusions: We conclude that comorbidities of diabetes and hypertension have detectable effects on OAB symptoms and treatment responses, but the small magnitude of these alterations does not justify changing existing paradigms for the clinical management of OAB.
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Affiliation(s)
- A. Elif Müderrisoglu
- Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Türkiye
| | - Ayse A. Sakul
- Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Türkiye
| | | | | | - Martin C. Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- *Correspondence: Martin C. Michel,
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Prebay ZJ, Foss H, Ebbott D, Hyman J, Li M, Chung PH. Do Sodium-Glucose Co-Transporter 2 Inhibitors Increase the Risk of Urologic Implant Reintervention? Urology 2023; 174:191-195. [PMID: 36754235 DOI: 10.1016/j.urology.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To understand whether patients taking sodium-glucose co-transporter 2 inhibitors (SGLT2i) would be at a similar risk of genitourinary device infection or failure as patients not taking these medications. METHODS We queried the TriNetX database for all adult male patients undergoing artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) and compared patients taking SGLT2i against those not. Cohorts and outcomes were defined using current procedural terminology and International Classification of Diseases (ICD-10) codes. We used Age, body mass index, diabetes, smoking history and history of prostatectomy to generate propensity score matching. Our primary outcome was need for reintervention after implantation based on current procedural terminology codes. Secondary outcomes included infection rate and overall complication rate based on ICD-10 codes. Analytics were performed via TriNetX which calculated risk ratios. RESULTS Analyses were run on November 28, 2022. After propensity score matching, there were 319 and 83 patients in each IPP and AUS cohort and comorbidity profiles were similar. Patients with an IPP on an SGLT2i were at a lower risk of overall complication (10.6% vs 16.1%, RR 0.66, P = .049). There was similar rates for AUS and risk of complication and for either implant on risk of infection or reintervention. CONCLUSION Patients taking SGLT2is may be safely offered urologic implants. Patients taking an SGLT2 had a lower risk of complication for IPP, and there were similar rates of infection and reintervention for both IPP and AUS.
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Affiliation(s)
- Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Halle Foss
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - David Ebbott
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hyman
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Michael Li
- Center for Digital Health and Data Science, Thomas Jefferson University, Philadelphia, PA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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Rac1 as a Target to Treat Dysfunctions and Cancer of the Bladder. Biomedicines 2022; 10:biomedicines10061357. [PMID: 35740379 PMCID: PMC9219850 DOI: 10.3390/biomedicines10061357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/28/2022] Open
Abstract
Bladder pathologies, very common in the aged population, have a considerable negative impact on quality of life. Novel targets are needed to design drugs and combinations to treat diseases such as overactive bladder and bladder cancers. A promising new target is the ubiquitous Rho GTPase Rac1, frequently dysregulated and overexpressed in bladder pathologies. We have analyzed the roles of Rac1 in different bladder pathologies, including bacterial infections, diabetes-induced bladder dysfunctions and bladder cancers. The contribution of the Rac1 protein to tumorigenesis, tumor progression, epithelial-mesenchymal transition of bladder cancer cells and their metastasis has been analyzed. Small molecules selectively targeting Rac1 have been discovered or designed, and two of them—NSC23766 and EHT 1864—have revealed activities against bladder cancer. Their mode of interaction with Rac1, at the GTP binding site or the guanine nucleotide exchange factors (GEF) interaction site, is discussed. Our analysis underlines the possibility of targeting Rac1 with small molecules with the objective to combat bladder dysfunctions and to reduce lower urinary tract symptoms. Finally, the interest of a Rac1 inhibitor to treat advanced chemoresistance prostate cancer, while reducing the risk of associated bladder dysfunction, is discussed. There is hope for a better management of bladder pathologies via Rac1-targeted approaches.
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