Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors

Taraxacum mongolicum total triterpenoids and taraxasterol ameliorate benign prostatic hyperplasia by inhibiting androgen levels, inflammatory responses, and epithelial-mesenchymal transition via the TGFβ1/Smad signalling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Taraxacum mongolicum Hand.-Mazz. is a well-known plant used both medicinally and as food, commonly used in traditional Chinese medicine prescriptions to alleviate benign prostatic hyperplasia (BPH). However, the material basis and molecular mechanisms of T. mongolicum alone in improving BPH remain unclear. In recent years, triterpenoids have been considered to be a key chemical constituents for T. mongolicum to exert its biological activity.

AIM OF THE STUDY

To explore the therapeutic efficacy and underlying mechanism of total triterpenoids from T. mongolicum (TTM) and its active constituents against BPH.

MATERIALS AND METHODS

The chemical components of TTM were determined using UPLC-QTOF-MS analysis. We established a testosterone propionate (TP)-induced rat model of BPH to assess the potential of TTM in vivo. Subsequently, network pharmacology was combined with experimental results from a TGFβ1-stimulated BPH-1 cell model to reveal the molecular mechanism of TTM. The main active ingredient (taraxasterol, TAR) of TTM was screened by evaluating its antiproliferative ability against BPH-1 and WPMY cells. Eventually, RNA-sequencing, RT-qPCR, immunofluorescence, and Western blotting were employed to elucidate the potential molecular targets and signalling pathways of TAR in BPH rats.

RESULTS

TTM was mainly composed of ten pentacyclic triterpenoids and one phytosterol, including TAR, lupeol, β-amyrin, taraxerol, and their acetates. TTM ameliorated TP-induced BPH by decreasing androgen levels and repressing inflammatory responses and oxidative stress. Furthermore, TTM inhibited epithelial-mesenchymal transition (EMT) and extracellular matrix (ECM) deposition via impeding the TGFβ1/Smad signalling pathway in BPH-1 cells based on the network pharmacology. Among the main chemical components of TTM, TAR exerted the strongest antiproliferative activity in vitro, and inhibited the growth of BPH-1 and WPMY-1 cells in a concentration dependent manner. Importantly, TAR also reduced androgen levels and inflammatory responses to balance proliferation and apoptosis in BPH rats. Transcriptomic analysis showed that TAR attenuated collagen deposition in BPH by inhibiting ECM-receptor interaction pathway. In addition, TAR notably suppressed EMT and the TGFβ1/Smad signalling in BPH rats, as evidenced by reduced the protein levels of collagen I, a-SMA, Snail, TGFβ1, p-Smad2/Smad2, and p-Smad3/Smad3, alongside an increase in E-cadherin expression.

CONCLUSIONS

TTM or TAR could effectively improve TP-induced BPH by suppressing androgen levels, inflammatory response, and EMT via the TGFβ1/Smad signalling pathway. These findings may present new therapeutic approachs for BPH in clinical settings. Notably, this study is the first to systematically elucidate the therapeutic mechanism of triterpenoids from T. mongolicum in treating BPH.

Prospective observational study of oxidative stress in the pathology of benign prostatic hyperplasia with bladder diverticulum

BACKGROUND

Oxidative stress contributes to benign prostatic hyperplasia (BPH) pathogenesis, but its role in BPH with bladder diverticulum is unclear.

METHODS

This prospective cohort study compared 126 BPH patients at the Second Hospital of Harbin Medical University. The study involved two groups (n = 63 for each group): group A, comprising patients with BPH, and group B, consisting of BPH patients with bladder diverticulum. Ultrasound imaging and CT scans were employed to assess the features of BPH and bladder diverticulum, respectively. Various clinical parameters and oxidative stress biomarkers were compared between the groups.

RESULTS

Group B exhibited significantly higher creatinine (101.8 ± 27.6 µmol/L vs. 56.1 ± 23.6 µmol/L, p < 0.0001), WBC counts (7.0 ± 1.9 vs. 4.2 ± 1.3 × 10⁹/L, p < 0.0001), residual urine volume (400.1 ± 252.0 mL vs. 150.7 ± 93.9 mL, p < 0.0001), and oxidative stress markers, including 8-OHdG (1.93 ± 0.58 vs. 1.70 ± 0.73 ng/mg creatinine, p = 0.014) and MDA (2.46 ± 0.57 vs. 2.03 ± 0.57 μmol/L, p < 0.0001). In group A, 8-OHdG positively correlated with residual urine volume (rho = 0.68) and nitric oxide with bladder wall thickness (rho = 0.70), while quality of life (QoL) negatively correlated with nitric oxide (rho = -0.76). In group B, oxidative stress markers correlated positively with BMI (e.g., homocysteine, rho = 0.69) and bladder wall thickness (e.g., nitric oxide, rho = 0.69), with QoL negatively correlated with uric acid (rho = -0.78).

CONCLUSIONS

Bladder diverticulum in BPH patients is associated with elevated oxidative stress, increased inflammation, and impaired bladder function.

Benign Prostatic Hyperplasia Increases Long-term Chronic Kidney Disease Risk

OBJECTIVE

To assess the long-term association between benign prostatic hyperplasia (BPH) and chronic kidney disease (CKD) while considering the potential role of BPH medications in any observed associations.

METHODS

This study used a prospective cohort design. A total of 198,399 male patients without CKD at baseline were recruited from the UK Biobank from 2006 to 2010. Cox proportional hazards models were used to analyze the relationships between BPH, its medication, and the incidence of CKD and end-stage kidney disease (ESKD).

RESULTS

After a median follow-up of 13.58 years, 3710 patients with BPH were diagnosed with CKD (hazard ratio [HR], 1.26; 95% CI, 1.10 to 1.45), and 322 patients with BPH were diagnosed with ESKD (HR, 1.49; 95% CI, 0.72 to 3.08), compared with non-BPH patients. Furthermore, BPH medication significantly increased the risk of CKD (HR, 1.48; 95% CI, 1.18 to 1.85) in individuals with BPH compared with those without medication.

CONCLUSION

This study found that people with BPH and those taking BPH medications have a higher long-term risk of CKD. Benign prostatic hyperplasia may contribute to the progression of CKD to ESKD. These findings highlight the importance of monitoring kidney function in patients with BPH.

Protective effect of the hydroethanolic extract of camelthorn (Alhagi maurorum) on benign prostatic hyperplasia induced by testosterone in rats

BACKGROUND

One of the Iranian medicinal plants is Alhagi maurorum, which belongs to the Fabaceae family. The plant is used to treat different conditions, such as aphthous ulcers, cardiac pains, hemorrhoids, kidney stones, dysuria, etc. Given that A. maurorum is characterized by its richness in flavonoids and phenolic compounds, and it is used to treat urinary tract disorders, this study aimed to investigate the protective effects of its hydroethanolic extract in a rat model of benign prostatic hyperplasia (BPH).

METHODS

After preparing the hydroethanolic extract, phytochemical analysis, including GC-MS, was conducted. Adult male Wistar rats (n:35) were randomly divided into five groups (n:7): A sham surgery was conducted on the first group, while the other four groups underwent castration through the scrotal route. Seven days after the surgery, benign prostatic hyperplasia (BPH) was induced in all groups except the first one, using a subcutaneous injection of testosterone propionate at a dosage of 10 mg/kg/day. The treatment duration lasted 28 days, during which the animals received oral treatments as follows: 1. Sham control: normal saline, 2. Positive control (BPH group): normal saline, 3. Comparative control: finasteride at 5 mg/kg/day, 4. T1 group: A. maurorum extract at 200 mg/kg/day, and 5. T2 group: A. maurorum extract at 400 mg/kg/day. At the end of the experiment, following an overnight fast and after administering anesthesia with ketamine and xylazine, blood was collected through cardiac puncture, and sera were harvested for hormone assay. Finally after euthanizing the rats, the ventral prostatic lobes were dissected for biochemical, histopathological, and gene expression analyses.

RESULTS

GC-MS analysis showed the presence of nine components. A. maurorum extract and/or Finasteride led to a significant reduction of the prostate weight and prostatic index, serum, and prostatic levels of testosterone. These compounds led to the downregulation of 5-α reductase and androgen receptor genes expression, boosted total antioxidant capacity, and declined prostatic malondialdehyde levels. Intervention using the extract, comparable to Finasteride, led to BPH-induced histopathological enhancements in the prostate.

CONCLUSION

Treatment using A. maurorum extract resulted in significant protection of the prostate against BPH, which is attributable to its antioxidant and androgen-modulating characteristics.

Emerging drugs for the treatment of benign prostatic hyperplasia: a 2023 update

INTRODUCTION

Benign prostatic hyperplasia (BPH) is a condition that affects over 50% of men as they enter their fifth decade of life, often leading to lower urinary tract symptoms (LUTS). Primary treatment options include alpha blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 inhibitors. However, these medications can have some side effects, and there is a noticeable dearth of information addressing the long-term use of these medications. Thus, the exploration of all treatment modalities helps ensure patients receive personalized and effective care. Consequently, the primary objective of this review is to identify potential emerging medications for the treatment of BPH.

AREAS COVERED

We conducted an extensive review of articles discussing pharmacotherapy for BPH spanning the last 15 years. Our information gathering process involved Scopus, PubMed-MEDLINE, Cochrane, Wiley Online Library Google Scholar, ClinicalTrials.gov, and the PharmaProjects database. This approach ensures that readers gain an in-depth knowledge of the existing therapeutic agents as well as promising avenues for managing BPH.

EXPERT OPINION

BPH treatment targets a patient's specific constellation of symptoms. Therefore, a broad knowledge base encompassing various treatment options is paramount in ensuring optimal treatment. Looking forward, the emphasis on personalization promises to reshape the landscape of BPH treatment and improve patient outcomes.

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis

Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.

The human microbiome and benign prostatic hyperplasia: Current understandings and clinical implications

The research of the human microbiome in the preceding decade has yielded novel perspectives on human health and diseases. Benign prostatic hyperplasia (BPH) is a common disease in middle-aged and elderly males, which negatively affects the life quality. Existing evidence has indicated that the human microbiome, including urinary, intra-prostate, gut, oral and blood microbiome may exert a significant impact on the natural progression of BPH. The dysbiosis of the microbiome may induce inflammation at either a local or systemic level, thereby affecting the BPH. Moreover, metabolic syndrome (MetS) caused by the microbiome can also be involved in the development of BPH. Additionally, alterations in the microbiome composition during the senility process may serve as another cause of the BPH. Here, we summarize the influence of human microbiome on BPH and explore how the microbiome is linked to BPH through inflammation, MetS, and senility. In addition, we propose promising areas of investigation and discuss the implications for advancing therapeutic approaches.

Omentin-1 inhibits the development of benign prostatic hyperplasia by attenuating local inflammation

BACKGROUND

Benign prostatic hyperplasia (BPH) is a prevalent disease affecting elderly men, with chronic inflammation being a critical factor in its development. Omentin-1, also known as intelectin-1 (ITLN-1), is an anti-inflammatory protein primarily found in the epithelial cells of the small intestine. This study aimed to investigate the potential of ITLN-1 in mitigating BPH by modulating local inflammation in the prostate gland.

METHODS

Our investigation involved two in vivo experimental models. Firstly, ITLN-1 knockout mice (Itln-1-/-) were used to study the absence of ITLN-1 in BPH development. Secondly, a testosterone propionate (TP)-induced BPH mouse model was treated with an ITLN-1 overexpressing adenovirus. We assessed BPH severity using prostate weight index and histological analysis, including H&E staining, immunohistochemistry, and enzyme-linked immunosorbent assay. In vitro, the impact of ITLN-1 on BPH-1 cell proliferation and inflammatory response was evaluated using cell proliferation assays and enzyme-linked immunosorbent assay.

RESULTS

In vivo, Itln-1-/- mice exhibited elevated prostate weight index, enlarged lumen area, and higher TNF-α levels compared to wild-type littermates. In contrast, ITLN-1 overexpression in TP-induced BPH mice resulted in reduced prostate weight index, lumen area, and TNF-α levels. In vitro studies indicated that ITLN-1 suppressed the proliferation of prostate epithelial cells and reduced TNF-α production in macrophages, suggesting a mechanism involving the inhibition of macrophage-mediated inflammation.

CONCLUSION

The study demonstrates that ITLN-1 plays a significant role in inhibiting the development of BPH by reducing local inflammation in the prostate gland. These findings highlight the potential of ITLN-1 as a therapeutic target in the management of BPH.

Treatment of Benign Prostatic Hyperplasia by Natural Drugs

Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy.