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Gunduz A, Valls-Solé J, Serranová T, Coppola G, Kofler M, Jääskeläinen SK. The blink reflex and its modulation - Part 2: Pathophysiology and clinical utility. Clin Neurophysiol 2024; 160:75-94. [PMID: 38412746 DOI: 10.1016/j.clinph.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/30/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
The blink reflex (BR) is integrated at the brainstem; however, it is modulated by inputs from various structures such as the striatum, globus pallidus, substantia nigra, and nucleus raphe magnus but also from afferent input from the peripheral nervous system. Therefore, it provides information about the pathophysiology of numerous peripheral and central nervous system disorders. The BR is a valuable tool for studying the integrity of the trigemino-facial system, the relevant brainstem nuclei, and circuits. At the same time, some neurophysiological techniques applying the BR may indicate abnormalities involving structures rostral to the brainstem that modulate or control the BR circuits. This is a state-of-the-art review of the clinical application of BR modulation; physiology is reviewed in part 1. In this review, we aim to present the role of the BR and techniques related to its modulation in understanding pathophysiological mechanisms of motor control and pain disorders, in which these techniques are diagnostically helpful. Furthermore, some BR techniques may have a predictive value or serve as a basis for follow-up evaluation. BR testing may benefit in the diagnosis of hemifacial spasm, dystonia, functional movement disorders, migraine, orofacial pain, and psychiatric disorders. Although the abnormalities in the integrity of the BR pathway itself may provide information about trigeminal or facial nerve disorders, alterations in BR excitability are found in several disease conditions. BR excitability studies are suitable for understanding the common pathophysiological mechanisms behind various clinical entities, elucidating alterations in top-down inhibitory systems, and allowing for follow-up and quantitation of many neurological syndromes.
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Affiliation(s)
- Aysegul Gunduz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Division of Neurophysiology, Istanbul, Turkey.
| | - Josep Valls-Solé
- IDIBAPS. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170 08024, Barcelona, Spain.
| | - Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, Charles University, Prague 1st Faculty of Medicine and General University Hospital, Prague, Kateřinská 30, 12800 Prague 2, Czech Republic.
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, via Franco Faggiana 1668 04100, Latina, Italy.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, A-6170 Zirl, Austria.
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Division of Medical Imaging, Turku University Hospital and University of Turku, Postal Box 52, FIN 20521 Turku, Finland.
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Zhang X, Ma L, Li J, Zhang W, Xie Y, Wang Y. Mental health and lower urinary tract symptoms: Results from the NHANES and Mendelian randomization study. J Psychosom Res 2024; 178:111599. [PMID: 38309129 DOI: 10.1016/j.jpsychores.2024.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The clinical observations suggest a correlation between lower urinary tract symptoms (LUTSs) and mental health problems. Nonetheless, establishing a direct causal relationship between them remains challenging. METHODS We initially conducted a cross-sectional study using 2005-2018 the National Health and Nutrition Examination Survey (NHANES) data. Multivariable-adjusted logistic regression was the primary statistical approach. Additionally, we employed Mendelian randomization (MR) to reducing confounding and reverse causation. Genetic instruments were obtained from publicly available genome-wide association study (GWAS) databases. Inverse Variance Weighted was the primary statistical method. RESULTS The cross-sectional study involved 29,439 participants. Individuals with mental health problems had a higher risk of urinary incontinence (OR:4.38; 95%CI:3.32-5.76; P < 0.01) and overactive bladder (OR:2.31; 95%CI:2.02-2.63; P < 0.01). MR analysis then indicated a potential causal relationship between mental health problems and LUTSs. Depression symptoms was linked with urinary tract infection (UTI) (OR:1.005; 95%CI:1.003-1.008; PFDR < 0.01). Anxiety symptoms was related to the occurrence of UTI (OR:1.024; 95%CI:1.011-1.037; PFDR < 0.01) and bladder calcified/ contracted/ overactive (OR:1.017; 95%CI:1.007-1.027; PFDR < 0.01). The personality trait of neuroticism was related to the occurrence of cystitis (OR:1.072; 95%CI:1.022-1.125; PFDR = 0.02), extravasation of urine and difficulties with micturition (OR:1.001; 95%CI:1.001-1.002; PFDR < 0.01), and urinary frequency and incontinence (OR: 1.001; 95%CI:1.000-1.001; PFDR < 0.01). CONCLUSIONS Our study provides various evidence for the correlation between mental health and LUTSs, emphasizing the significance of adopting a holistic approach to LUTSs management that incorporates both physical and psychological factors.
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Affiliation(s)
- Xiaotian Zhang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Leilei Ma
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jing Li
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wei Zhang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yiran Xie
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yaoguang Wang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
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Yang Y, Zhang H, Lu Q, Liu X, Fan Y, Zhu J, Sun B, Zhao J, Dong X, Li L. Suppression of adenosine A 2a receptors alleviates bladder overactivity and hyperalgesia in cyclophosphamide-induced cystitis by inhibiting TRPV1. Biochem Pharmacol 2020; 183:114340. [PMID: 33189675 DOI: 10.1016/j.bcp.2020.114340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a type of chronic bladder inflammation characterized by increased voiding frequency, urgency and pelvic pain. The sensitization of bladder afferents is widely regarded as one of the pathophysiological changes in the development of IC/BPS. There is evidence that adenosine A2a receptors are involved in regulating the sensitization of sensory afferents. However, the effect of adenosine A2a receptors on cystitis remains unknown. In the present study, a rat model of chronic cystitis was established by intraperitoneal injection with cyclophosphamide (CYP). Cystometry and behavioral tests were performed to investigate bladder micturition function and nociceptive pain. The rats with chronic cystitis showed symptoms of bladder overactivity, characterized by an increase in bladder voiding frequency and voiding pressure. CYP treatment significantly increased the expression of the A2a receptor in bladder afferent fibers and dorsal root ganglion (DRG) neurons. The A2a receptor antagonist ZM241385 prevented bladder overactivity and hyperalgesia elicited by CYP-induced cystitis. In addition, the A2a receptor and TRPV1 were coexpressed on DRG neurons. The TRPV1 antagonist capsazepine blocked bladder overactivity induced by the A2a receptor agonist CGS21680. In contrast, ZM241385 significantly inhibited the capsaicin-induced increase in intracellular calcium concentration in DRG neurons. These results suggest that suppression of adenosine A2a receptors in bladder afferents alleviates bladder overactivity and hyperalgesia elicited by CYP-induced cystitis in rats by inhibiting TRPV1, indicating that the adenosine A2a receptor in bladder afferents is a potential therapeutic target for the treatment of IC/BPS.
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Affiliation(s)
- Yang Yang
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Hengshuai Zhang
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Qudong Lu
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xin Liu
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Yi Fan
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Jingzhen Zhu
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Bishao Sun
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Jiang Zhao
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xingyou Dong
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China.
| | - Longkun Li
- Department of Urology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China.
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Augé C, Gamé X, Vergnolle N, Lluel P, Chabot S. Characterization and Validation of a Chronic Model of Cyclophosphamide-Induced Interstitial Cystitis/Bladder Pain Syndrome in Rats. Front Pharmacol 2020; 11:1305. [PMID: 32982733 PMCID: PMC7485435 DOI: 10.3389/fphar.2020.01305] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
Interstitial cystitis/Bladder Pain Syndrome (IC/BPS) is a chronic inflammatory disease characterized by visceral pain and voiding symptoms. IC/BPS is still an unsolved enigma with ineffective diagnosis criteria and treatment. A main limitation in IC/BPS understanding is the lack of appropriate preclinical model. Cyclophosphamide (CYP) is commonly used as an experimental model for IC/BPS in rodent. However, the proposed models are very aggressive, contrasting with what occurs in clinic, and often associated with severe toxicity and high mortality rate. In addition, visceral pain, the hallmark symptom of IC/BPS, has been validated in only few of them. In this study, we developed a chronic model of CYP-induced IC/BPS in female rat. In our protocol, no severe weight loss occurred and the survival rate was 100%. In accordance to human pathology, chronic CYP-injected rats developed severe painful behavior whereas only sparse inflammation was observed. Inflammatory response was characterized by bladder edema and focal urothelial damage but absence of massive infiltrate. This chronic model showed persistent symptoms indicative for a central sensitization mechanism. We further demonstrate that CYP-induced chronic visceral pain was significantly reduced by curative treatment with clinically relevant compounds (gabapentin, ibuprofen, and Ialuril®). We therefore developed and validated a rat model of chronic cystitis that shares strong similarity with human non-ulcerative IC/BPS features without overtly affecting the animal health. This model will thus provide mechanistic insights of the disease and help to evaluate therapeutic agents for IC/BPS.
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Affiliation(s)
- Céline Augé
- Department of Pain and Inflammation, Urosphere, Toulouse, France
| | - Xavier Gamé
- Urology Department, Rangueil University Hospital, Toulouse, France.,INSERM, I2MC-U1048, CHU Rangueil, Toulouse, France
| | | | - Philippe Lluel
- Department of Pain and Inflammation, Urosphere, Toulouse, France
| | - Sophie Chabot
- Department of Pain and Inflammation, Urosphere, Toulouse, France
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Holschneider DP, Wang Z, Chang H, Zhang R, Gao Y, Guo Y, Mao J, Rodriguez LV. Ceftriaxone inhibits stress-induced bladder hyperalgesia and alters cerebral micturition and nociceptive circuits in the rat: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome research network study. Neurourol Urodyn 2020; 39:1628-1643. [PMID: 32578247 DOI: 10.1002/nau.24424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
AIMS Emotional stress plays a role in the exacerbation and development of interstitial cystitis/bladder pain syndrome (IC/BPS). Given the significant overlap of brain circuits involved in stress, anxiety, and micturition, and the documented role of glutamate in their regulation, we examined the effects of an increase in glutamate transport on central amplification of stress-induced bladder hyperalgesia, a core feature of IC/BPS. METHODS Wistar-Kyoto rats were exposed to water avoidance stress (WAS, 1 hour/day x 10 days) or sham stress, with subgroups receiving daily administration of ceftriaxone (CTX), an activator of glutamate transport. Thereafter, cystometrograms were obtained during bladder infusion with visceromotor responses (VMR) recorded simultaneously. Cerebral blood flow (CBF) mapping was performed by intravenous injection of [14 C]-iodoantipyrine during passive bladder distension. Regional CBF was quantified in autoradiographs of brain slices and analyzed in three dimensional reconstructed brains with statistical parametric mapping. RESULTS WAS elicited visceral hypersensitivity during bladder filling as demonstrated by a decreased pressure threshold and VMR threshold triggering the voiding phase. Brain maps revealed stress effects in regions noted to be responsive to bladder filling. CTX diminished visceral hypersensitivity and attenuated many stress-related cerebral activations within the supraspinal micturition circuit and in overlapping limbic and nociceptive regions, including the posterior midline cortex (posterior cingulate/anterior retrosplenium), somatosensory cortex, and anterior thalamus. CONCLUSIONS CTX diminished bladder hyspersensitivity and attenuated regions of the brain that contribute to nociceptive and micturition circuits, show stress effects, and have been reported to demonstrated altered functionality in patients with IC/BPS. Glutamatergic pharmacologic strategies modulating stress-related bladder dysfunction may be a novel approach to the treatment of IC/BPS.
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Affiliation(s)
| | - Zhuo Wang
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Huiyi Chang
- Department of Urology, University of Southern California, Los Angeles, California.,Reeve-Irvine Research Center, University of California, Irvine, California
| | - Rong Zhang
- Department of Urology, University of Southern California, Los Angeles, California
| | - Yunliang Gao
- Department of Urology, University of Southern California, Los Angeles, California.,Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yumei Guo
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Jackie Mao
- Department of Urology, University of Southern California, Los Angeles, California
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California
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Hanzlíková Z, Kofler M, Slovák M, Věchetová G, Fečíková A, Kemlink D, Sieger T, Růžička E, Valls‐Solé J, Edwards MJ, Serranová T. Prepulse inhibition of the blink reflex is abnormal in functional movement disorders. Mov Disord 2019; 34:1022-1030. [DOI: 10.1002/mds.27706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Zuzana Hanzlíková
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Markus Kofler
- Department of NeurologyHochzirl Hospital Hochzirl Austria
| | - Matěj Slovák
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Anna Fečíková
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
- Department of Cybernetics, Faculty of Electrical EngineeringCzech Technical University in Prague Prague Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Josep Valls‐Solé
- Neurology Service, Hospital Clíınic, Facultad de MedicinaUniversitat de Barcelona Barcelona Spain
| | - Mark J. Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical SciencesSt George's University of London London United Kingdom
| | - Tereza Serranová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
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7
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Devilbiss DM. Consequences of tuning network function by tonic and phasic locus coeruleus output and stress: Regulating detection and discrimination of peripheral stimuli. Brain Res 2018; 1709:16-27. [PMID: 29908165 DOI: 10.1016/j.brainres.2018.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 12/15/2022]
Abstract
Flexible and adaptive behaviors have evolved with increasing complexity and numbers of neuromodulator systems. The neuromodulatory locus coeruleus-norepinephrine (LC-NE) system is central to regulating cognitive function in a behaviorally-relevant and arousal-dependent manner. Through its nearly ubiquitous efferent projections, the LC-NE system acts to modulate neuron function on a cell-by-cell basis and exert a spectrum of actions across different brain regions to optimize target circuit function. As LC neuron activity, NE signaling, and arousal level increases, cognitive performance improves over an inverted-U shaped curve. Additionally, LC neurons burst phasically in relation to novel or salient sensory stimuli and top-down decision- or response-related processes. Together, the variety of LC activity patterns and complex actions of the LC-NE system indicate that the LC-NE system may dynamically regulate the function of target neural circuits. The manner in which neural networks encode, represent, and perform neurocomputations continue to be revealed. This has improved our ability to understand the optimization of neural circuits by NE and generation of flexible and adaptive goal-directed behaviors. In this review, the rat vibrissa somatosensory system is explored as a model neural circuit to bridge known modulatory actions of NE and changes in cognitive function. It is argued that fluid transitions between neural computational states reflect the ability of this sensory system to shift between two principal functions: detection of novel or salient sensory information and detailed descriptions of sensory information. Such flexibility in circuit function is likely critical for producing context-appropriate sensory signal processing. Nonetheless, many challenges remain including providing a causal link between NE mediated changes in sensory neural coding and perceptual changes, as well as extending these principles to higher cognitive functions including behavioral flexibility and decision making.
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Affiliation(s)
- David M Devilbiss
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, United States.
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Reynolds WS, Dmochowski R, Wein A, Bruehl S. Does central sensitization help explain idiopathic overactive bladder? Nat Rev Urol 2016; 13:481-91. [PMID: 27245505 PMCID: PMC4969200 DOI: 10.1038/nrurol.2016.95] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The pathophysiological mechanisms underlying overactive bladder syndrome (OAB) can include dysfunction of sensory pathways of the peripheral and central nervous systems, resulting in bladder hypersensitivity. Central sensitization describes an induced state of spinal hypersensitivity that is associated with a variety of chronic pain disorders that share many attributes with OAB, albeit without the presence of pain. As such, the concept of central sensitization might be relevant to understanding the mechanisms and clinical manifestations of OAB syndrome. An understanding of the pathophysiology and clinical manifestations of central sensitization, and the evidence that supports a role of central sensitization in OAB, including the potential implications of mechanisms of central sensitization for the treatment of patients with OAB could provide a novel approach to the treatment of patients with this disease. Such an approach would be especially relevant to those patients with central sensitization-related comorbidities, and has the potential to improve the outcomes of these patients in particular.
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Affiliation(s)
- W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232, USA
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232, USA
| | - Alan Wein
- Division of Urology, University of Pennsylvania Health System, 34th &Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 701 Medical Arts Building, Nashville, Tennessee 37232, USA
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9
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Warren JW. Bladder pain syndrome/interstitial cystitis as a functional somatic syndrome. J Psychosom Res 2014; 77:510-5. [PMID: 25455811 DOI: 10.1016/j.jpsychores.2014.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/19/2014] [Accepted: 10/02/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE To determine whether bladder pain syndrome/interstitial cystitis (BPS/IC) has the characteristics of a functional somatic syndrome (FSS). MATERIALS AND METHODS There is no accepted definition of an FSS. Consequently, this paper reviewed the literature for common FSS characteristics and for reports that BPS/IC has these characteristics. RESULTS Eleven articles met inclusion and exclusion criteria and yielded 18 FSS characteristics. BPS/IC patients manifest all but two: the exceptions were normal light microscopic anatomy (after hydrodistention under anesthesia, some BPS/IC bladders have Hunner's lesions and most have petechial hemorrhages) and normal laboratory tests (many BPS/IC patients have hematuria). Petechial hemorrhages and hematuria are probably related and may appear during naturally-occurring bladder distention. Without such distention, then, the 90% of BPS/IC patients without a Hunner's lesion have all the characteristics of an FSS. Comparisons in the opposite direction were consistent: several additional features of BPS/IC were found in FSSs. CONCLUSIONS This systematic but untested method is consistent with but does not test the hypothesis that BPS/IC in some patients might best be understood as an FSS. Like most conditions, BPS/IC is probably heterogeneous; hence only a proportion of BPS/IC cases are likely to be manifestations of an FSS. This hypothesis has several implications. Explorations of processes that connect the FSSs might contribute to understanding the pathogenesis of BPS/IC. Patients with FSSs are at risk for BPS/IC and may benefit from future preventive strategies. Therapies that are useful in FSSs also may be useful in some cases of BPS/IC.
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Affiliation(s)
- John W Warren
- Department of Medicine, University of Maryland School of Medicine, 10 South Pine Street, #900, Baltimore, MD 21201, United States; Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
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Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn 2014; 33:611-7. [PMID: 24844598 DOI: 10.1002/nau.22582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the frequency of phenotype profiling of patients with idiopathic overactive bladder (OAB) syndrome, and to determine the effectiveness of treatment among individuals with different pathophysiologic profiles. METHODS The electronic databases MEDLINE, EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL were searched from January 1, 1980 to August 12, 2013 for interventional randomized controlled treatment trials (RCTs) of idiopathic OAB. Phenotying for pathophysiologies originating in the urothelial/mucosal layer of the bladder, the detrusor muscle cell layer, and the central nervous system were sought. Articles that analyzed urgency outcomes based on pathophysiologic profiling were selected. Due to the heterogeneity of the included interventions and outcome assessment measures, meta-analysis was not appropriate and a qualitative synthesis was undertaken. RESULTS Of 239 original RCTs of idiopathic OAB, 48 (20%) profiled participants on underlying pathophysiology. Less than half of these (n = 20) reported treatment efficacy for urgency symptoms by pathophysiological sub-type. One examined the effect of botulinum A toxin on interstitial cell protein expression. Four compared treatment efficacy in OAB patients with and without involuntary detrusor contractions. Fifteen compared the effect of treatment on urgency reduction in patients with detrusor overactivity. There were no consistent trends in treatment efficacy according to pathophysiologic sub-type. No studies examined urothelial dysfunction or abnormal central processing of bladder afferent signaling in response to treatment. CONCLUSIONS In order to advance the field of idiopathic OAB, more trials are needed that profile and test urgency outcomes in participants according to suspected underlying pathophysiology. Neurourol. Urodynam. 33:611-617, 2014. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Ann T Hanna-Mitchell
- University Hospitals Case Medical Center and Department of Urology, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
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11
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Alterations in resting state oscillations and connectivity in sensory and motor networks in women with interstitial cystitis/painful bladder syndrome. J Urol 2014; 192:947-55. [PMID: 24681331 DOI: 10.1016/j.juro.2014.03.093] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The pathophysiology of interstitial cystitis/painful bladder syndrome remains incompletely understood but is thought to involve central disturbance in the processing of pain and viscerosensory signals. We identified differences in brain activity and connectivity between female patients with interstitial cystitis/painful bladder syndrome and healthy controls to advance clinical phenotyping and treatment efforts for interstitial cystitis/painful bladder syndrome. MATERIALS AND METHODS We examined oscillation dynamics of intrinsic brain activity in a large sample of well phenotyped female patients with interstitial cystitis/painful bladder syndrome and female healthy controls. Data were collected during 10-minute resting functional magnetic resonance imaging as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network project. The blood oxygen level dependent signal was transformed to the frequency domain. Relative power was calculated for multiple frequency bands. RESULTS Results demonstrated altered frequency distributions in viscerosensory (post insula), somatosensory (postcentral gyrus) and motor regions (anterior paracentral lobule, and medial and ventral supplementary motor areas) in patients with interstitial cystitis/painful bladder syndrome. Also, the anterior paracentral lobule, and medial and ventral supplementary motor areas showed increased functional connectivity to the midbrain (red nucleus) and cerebellum. This increased functional connectivity was greatest in patients who reported pain during bladder filling. CONCLUSIONS Findings suggest that women with interstitial cystitis/painful bladder syndrome have a sensorimotor component to the pathological condition involving an alteration in intrinsic oscillations and connectivity in a cortico-cerebellar network previously associated with bladder function.
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12
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Malykhina A, Hanno P. How are we going to make progress treating bladder pain syndrome? ICI-RS 2013. Neurourol Urodyn 2014; 33:625-9. [PMID: 24615847 DOI: 10.1002/nau.22575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/27/2014] [Indexed: 12/24/2022]
Abstract
AIMS To look at the current state of knowledge in bladder pain syndrome and ascertain how we can make advances in the near term. METHODS A compendium of the ideas presented at the International Consultation on Incontinence Research Society 2013 meeting of clinicians and basic scientists. RESULTS The meeting included the following topics: potential connection between defined and undefined IC/BPS; association between psychiatric disorders and IC/BPS; rationale for multimodal therapy approach in IC/BPS; and issues of a placebo control in human studies. CONCLUSIONS Translational research studies are still in need of improved animal models to study IC/BPS mechanisms and development of novel methods to objectively measure bladder pain in rodents. The need to try and develop better clinical therapies will best be met by proper phenotyping of this heterogeneous population and avoiding premature publication of clinical trials that are anecdotal and do not include randomized placebo control populations. Patients with Hunner's lesions should be identified prior to or in the course of clinical trials so that results in this subgroup can be evaluated.
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Affiliation(s)
- Anna Malykhina
- Division of Urology, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Zitnik GA, Clark BD, Waterhouse BD. The impact of hemodynamic stress on sensory signal processing in the rodent lateral geniculate nucleus. Brain Res 2013; 1518:36-47. [PMID: 23643838 PMCID: PMC4529672 DOI: 10.1016/j.brainres.2013.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/22/2013] [Accepted: 04/19/2013] [Indexed: 11/27/2022]
Abstract
Hemodynamic stress via hypotensive challenge has been shown previously to cause a corticotropin-releasing factor (CRF)-mediated increase in tonic locus coeruleus (LC) activity and consequent release of norepinephrine (NE) in noradrenergic terminal fields. Although alterations in LC-NE can modulate the responsiveness of signal processing neurons along sensory pathways, little is understood regarding how continuous CRF-mediated activation of LC-NE output due to physiologically relevant stressor affects downstream target cell physiology. The goal of the present study was to investigate the effects of a physiological stressor [hemodynamic stress via sodium nitroprusside (SNP) i.v.] on stimulus evoked responses of sensory processing neurons that receive LC inputs. In rat, the dorsal lateral geniculate nucleus (dLGN) of the thalamus is the primary relay for visual information and is a major target of the LC-NE system. We used extracellular recording techniques in the anesthetized rat monitor single dLGN neuron activity during repeated presentation of light stimuli before and during hemodynamic stress. A significant decrease in magnitude occurred, as well as an increase in latency of dLGN stimulus-evoked responses were observed during hemodynamic stress. In another group of animals the CRF antagonist DpheCRF12-41 was infused onto the ipsilateral LC prior to SNP administration. This infusion blocked the hypotension-induced changes in dLGN stimulus-evoked discharge. These results show that CRF-mediated increases in LC-NE due to hemodynamic stress disrupts the transmission of information along thalamic-sensory pathways by: (1) initially reducing signal transmission during onset of the stressor and (2) decreasing the speed of stimulus evoked sensory transmission.
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Affiliation(s)
- Gerard A Zitnik
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA.
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Hague DW, Stella JL, Buffington CAT. Effects of interstitial cystitis on the acoustic startle reflex in cats. Am J Vet Res 2013; 74:144-7. [PMID: 23270359 DOI: 10.2460/ajvr.74.1.144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare acoustic startle reflexes (ASRs) of healthy cats and cats with interstitial cystitis (IC). ANIMALS 28 healthy cats (11 males and 17 females) and 20 cats with IC (13 males and 7 females). PROCEDURES To evaluate the effect of neutering on ASRs, ASRs in neutered and unneutered healthy cats were measured. To evaluate the effect of housing facility acclimation on ASRs in cats with IC, ASRs were measured in cats with IC within 1 month after arrival at the housing facility and again 2 to 3 months after arrival. To evaluate the effect of the environment on ASRs, ASRs were evaluated in all cats with and without IC after acclimation but before and then after environmental enrichment. RESULTS Neutering led to a significant decrease in overall ASR in the healthy cats. Habituation to the housing facility resulted in a significant decrease in overall ASR of female but not male cats with IC. Environmental enrichment led to a significant decrease in ASR in cats with IC but not in healthy cats. CONCLUSIONS AND CLINICAL RELEVANCE The magnitude of the ASR appeared to be sensitive to environmental conditions and affected by sex, both in healthy cats and cats with IC. It was also higher in cats with IC versus healthy cats, except when cats were housed in a highly enriched environment. IMPACT FOR HUMAN MEDICINE Treatment approaches that include reduction of a patient's perception of environmental unpredictability may benefit humans with IC.
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Affiliation(s)
- Devon W Hague
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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Teichman JM. New Treatments for Painful Urological Conditions. J Urol 2013; 189:415-6. [DOI: 10.1016/j.juro.2012.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Joel M.H. Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Patrick BA, Das A, Jaiswal AK. NAD(P)H:quinone oxidoreductase 1 protects bladder epithelium against painful bladder syndrome in mice. Free Radic Biol Med 2012; 53:1886-93. [PMID: 22985937 PMCID: PMC3495563 DOI: 10.1016/j.freeradbiomed.2012.08.584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/23/2012] [Accepted: 08/24/2012] [Indexed: 11/23/2022]
Abstract
Painful bladder syndrome (PBS), or interstitial cystitis, is a poorly understood chronic disease that is characterized by thinning of the bladder epithelium and intense pain. Here we demonstrate that NAD(P)H:quinone oxidoreductase 1(-/-) (NQO1(-/-)) mice developed in our laboratory represent a new animal model of PBS. NQO1 is known to protect against physiological stress as well as protecting transcription factors against proteasomal degradation. In this study we demonstrate that NQO1 is necessary for bladder epithelium integrity and to prevent the development/progression of PBS. We observed downregulation of energy metabolism, adhesion, and apoptotic signaling cascades, which led to mitochondrial aberrations and profound alterations in energy metabolism, increased susceptibility to reactive oxygen species generation, and apoptosis in luminal epithelium in NQO1(-/-) mice that were absent in wild-type mice. These pathophysiological changes led to the incidence of PBS in NQO1(-/-) mice. Altogether, the results demonstrate for the first time that NQO1 is an endogenous factor in protection against PBS.
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Affiliation(s)
- Brad A Patrick
- Department of Pharmacology and Experimental Therapeutics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Do urinary calculi increase risk of bladder pain syndrome? Nat Rev Urol 2012; 9:607-8. [DOI: 10.1038/nrurol.2012.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Developmental genetics and psychopathology: Some new feathers for a fine old hat. Dev Psychopathol 2012; 24:1165-77. [DOI: 10.1017/s0954579412000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractWithout even knowing of their existence, Mendel discovered how genes operate when they are completely penetrant, although they rarely are, at least with respect to human personality and psychopathology; yet quantitative genetics results have conclusively demonstrated their substantial macrolevel influence. Now we need to understand just how incompletely penetrant genes make their contributions to psychopathology. Exciting new developments in molecular genetics and epigenetics provide new insight into gene action in principle but have been of limited value so far in understanding the emergence of psychopathology. Some of the most helpful postulates might come from evolutionary and developmental biology and agricultural breeding experiments. I describe the all but forgotten evolutionary mechanisms articulated by Schmalhausen, a Russian evolutionary biologist whose work was suppressed by Stalin in the 1940s. I focus on Schmalhausen's law, the observation that organisms living in conditions at the boundary of their tolerance in any one aspect of existence will be vulnerable to expression of genetic liabilities related to all other aspects of existence. I show how Schmalhausen's ideas are relevant to the results of a century-long corn-breeding experiment and the current concepts of facilitated variation and cryptic genetic variation. I then discuss the relevance of all of these to understanding genetic influences on personality and psychopathology.
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De Wachter S, Smith P, Tannenbaum C, Van Koeveringe G, Drake M, Wyndaele J, Chapple C. How should bladder sensation be measured?: ICI-RS 2011. Neurourol Urodyn 2012; 31:370-4. [DOI: 10.1002/nau.22214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/12/2012] [Indexed: 01/25/2023]
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Boutros NN, Peters R. Internal gating and somatization disorders: proposing a yet un-described neural system. Med Hypotheses 2011; 78:174-8. [PMID: 22088921 DOI: 10.1016/j.mehy.2011.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 10/19/2011] [Indexed: 11/25/2022]
Abstract
Medically unexplained symptoms (MUS) are a major medical burden and our current understanding of the pathophysiological process leading to their development remains minimal. While research has strongly linked chronic stress to the development of MUS the exact mechanisms and the reason for the many variations in the resultant symptomatology remain unclear. In this paper we advance the hypothesis that an internal (visceral) sensory gating system must exist akin to the much better studied external sensory gating system. The hypothesis is based on the observations that under normal conditions sensations of internal organs do not reach consciousness (i.e., filtered or gated out on a subconscious or preattentive level). As visceral sensations are usually perceived only when there is a pathological process affecting the organ, then failure of this internal gating system leading to the sensations arriving to consciousness must be interpreted by the brain to indicate pathology in this organ. If the hypothesis proves to be true and such a system does exist, the implications are many and significant including developing methods for assessing the system and possibly correcting it.
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Affiliation(s)
- Nash N Boutros
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, School of Medicine, College of Nursing, Detroit, MI 48207, United States.
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Abstract
Signs of lower urinary tract (LUT) disease in domestic cats can be acute or chronic, and can result from variable combinations of abnormalities within the lumen of the LUT, the parenchyma of the LUT itself, or other organ system(s) that then lead to LUT dysfunction. In the majority of cats with chronic signs of LUT dysfunction, no specific underlying cause can be confirmed after standard clinical evaluation of the LUT, so these cats typically are classified as having idiopathic cystitis. A syndrome in human beings commonly known as interstitial cystitis (IC) shares many features in common with these cats, permitting comparisons between the two species. A wide range of similarities in abnormalities has been identified between these syndromes outside as well as inside the LUT. A variety of potential familial and developmental risk factors also have been identified. These results have permitted generation of the hypothesis that some of these people have a disorder affecting the LUT rather than a disorder of the LUT. This perspective has suggested alternative diagnostic strategies and novel approaches to treatment, at least in cats. The purpose of this review is to summarize research investigations into the various abnormalities present in cats, to compare some of these findings with those identified in human beings, and to discuss how they might modify perceptions about the etiopathogenesis, diagnosis, and treatment of cats with this disease. Dedication: I dedicate this contribution to Professor Dennis J. Chew, whose collaboration, patience, and support made it all possible.
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Affiliation(s)
- C A T Buffington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA.
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