Current treatment of BPH

Circulating levels of blood biomarkers and risk of benign prostatic hyperplasia: Results from two large cohorts in Europe and East Asia

Background

As one of the most prevalent chronic non-communicable diseases affecting aging males, the burden of benign prostatic hyperplasia is growing over the world. Our study aims at investigating the potential relationships between various blood biomarkers and benign prostatic hyperplasia (BPH) in middle-aged and older men in European and East Asian population cohorts.

Methods

We included 229 022 male adults from the UK Biobank (UKB) and 20 284 male adults from the China Health and Retirement Longitudinal Study (CHARLS) in this study. Forty-four blood biomarkers in UKB cohort and 16 blood biomarkers in the CHARLS cohort were analysed to examine their association with benign prostatic hyperplasia. Cox, logistic analyses and restricted cubic spline models were used to investigate linear and nonlinear longitudinal associations.

Results

In our research, elevated high-density lipoprotein cholesterol showed significant associations with a decreased risk of benign prostatic hyperplasia, and these associations remained significant after accounting for potential covariates both in UKB cohort (hazard ratio (HR) = 0.83; 95% CI = 0.79-0.88, P < 0.001) and CHARLS cohort (odds ratio (OR) = 0.992; 95% CI = 0.985-0.999, P = 0.033). Apolipoprotein A was also found to be inversely associated with BPH (HR = 0.76; 95% CI = 0.70-0.81, P < 0.001). L-shaped relationships were discovered between level of high-density lipoprotein cholesterol and apolipoprotein A with incidence of benign prostatic hyperplasia.

Conclusions

This large prospective biomarker-based study highlights that high-density lipoprotein (HDL) cholesterol and apolipoprotein A are significant protective factors against the development of BPH, with L-shaped associations suggesting an optimal protective range. In contrast, biomarkers related to glucose metabolism, inflammation, and hormone levels were not found to significantly influence BPH progression. Our findings support the potential involvement of lipid biomarkers in the early stages of BPH development, suggesting that future strategies should prioritise lipid-related pathways in the prevention and management of BPH.

Ethanol extracts of saw palmetto contain the indirectly acting sympathomimetic: tyramine

BACKGROUND

To identify the bioactive components of saw palmetto ethanol extracts that affect contractility in the rat prostate gland.

METHODS

A commercially available saw palmetto ethanol extract was lyophilized then subjected to fractionation using silica gel column chromatography. Composition of fractions was assessed by proton nuclear magnetic resonance ((1)H NMR) spectroscopy and mass spectrometry (MS). Contractile activity of these fractions was evaluated pharmacologically using isolated preparations of rat prostate gland and compared to the activity of crude ethanol extract.

RESULTS

Saw palmetto ethanol extract caused contractions of the rat prostate gland which were consistent with indirectly acting sympathomimetic activity. Fractions resulting from chromatography produced contractions of isolated rat prostates that were similar in magnitude to the contractions produced by the crude extracts. Analysis of NMR and mass spectra revealed that this bioactivity was due to tyramine in the active fraction.

CONCLUSIONS

Tyramine is present in saw palmetto ethanol extracts and causes indirect α(1)-adrenoceptor mediated contractions via the release of noradrenaline from sympathetic neurons. This has clinical implications, as tyramine interacts with MAO inhibitors to cause hypertensive crisis.

Apoptosis induction by sulfur-containing compounds in malignant and nonmalignant human cells

Plants have traditionally represented a main source for the discovery of many biologically active substances with therapeutic values. Sulfur-containing compounds exhibit pleiotropic biological effects supporting their potential use in multitargeted cancer prevention and treatment. As potential anti-cancer agents, they have been shown to inhibit or retard the growth of various cancer cells in culture and implanted tumors in vivo. The compounds significantly inhibit experimental tumorigenesis in a wide range of animal models. A critical and well-elucidated cellular mechanism involved in the anticancer activities of sulfur-containing compounds is the induction of apoptosis through the fine-tuning of orchestrated intracellular signal transduction. This review summarizes the established proapoptotic activities of sulfur-containing compounds in malignant and nonmalignant cells with a special focus on their molecular mechanisms. The potential toxicological implications of proapoptotic effects on normal cells will also be discussed.

Finasteride 1 mg has no inhibitory effect on omeprazole metabolism in extensive and poor metabolizers for CYP2C19 in Japanese

OBJECTIVE

To examine the inhibitory effect of finasteride 1 mg on the metabolism of omeprazole in genetically determined extensive (EMs) and poor metabolizers (PMs) for CYP2C19 in young healthy Japanese male subjects.

METHODS

Twenty-four volunteers participated in this study, among whom 12 were homozygous EMs and 12 were PMs for CYP2C19. A single center, controlled, randomized, open, crossover study with a 5 day washout between the two study periods was performed. Each of the six EMs and PMs received a single oral 20 mg dose of omeprazole on day 1 (treatment I). After a 5 day washout period, these subjects received 1 mg of finasteride once a day for three consecutive days, and a single oral 20 mg dose of omeprazole was co-administered on day 3 (treatment II). The 12 other EMs and PMs received treatments I and II in reverse. Plasma samples were collected for up to a 12 hours postdose of omeprazole, and the pharmacokinetic parameters of omeprazole were determined.

RESULTS

The geometric mean ratio (GMR) for the AUC((0-12 hr)) of omeprazole when co-administered with finasteride/omeprazole alone is 1.13 (90%CI, 1.03, 1.25) and 0.96 (0.88, 1.05) in EMs and PMs, respectively. Finasteride did not significantly alter C(max), T(max) and t(1/2) in both genotypes.

CONCLUSION

Finasteride 1 mg, widely used for the treatment of androgenetic alopecia in men, did not meaningfully increase omeprazole exposure (20 mg) in both EMs and PMs for CYP2C19. These results indicate that finasteride does not meaningfully inhibit CYP2C19 activity in vivo at the dose of 1 mg.

Saw palmetto is an indirectly acting sympathomimetic in the rat-isolated prostate gland

BACKGROUND

To investigate whether saw palmetto that inhibits alpha1-adrenoceptor binding in vitro affects contractility of the rat prostate gland.

METHODS

The effects of a commercially available saw palmetto extract were examined on the contractility of rat-isolated prostate glands. The extract was tested in the presence and absence of phentolamine, prazosin, yohimbine, propranolol, hexamethonium, cocaine, desipramine, nifedipine, guanethidine, atropine, and alpha,beta-methylene ATP to evaluate the mechanism of action. Isolated preparations of rat vas deferens and bladder were used for comparison.

RESULTS

Unexpectedly, saw palmetto extract caused contractions of the rat prostate gland that could be attenuated by prazosin, phentolamine, nifedipine, guanethidine, cocaine, and desipramine but not by any of the other pharmacological tools. Similar contractile effects were observed in rat-isolated vas deferens preparations but not in rat-isolated bladder preparations.

CONCLUSIONS

In the rat prostate gland, saw palmetto extract causes indirect alpha1-adrenoceptor-mediated contractions via the release of noradrenaline from sympathetic neurons.