Association between metabolic syndrome and benign prostatic hyperplasia: The underlying molecular connection

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.

SGLT2 Inhibitors in Patients with Urogenital Malformations and Urinary Diversions: Risks, Benefits, and Clinical Considerations

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are increasingly used in patients with type 2 diabetes, chronic kidney disease, and heart failure. However, their safety and efficacy in patients with congenital or surgically altered urogenital anatomy remains underexplored. Methods: We conducted a narrative review of current evidence regarding the use of SGLT2i in patients with urinary tract malformations, urinary diversions, and functional voiding disorders. Key risks, clinical considerations, and management strategies were synthesized from the existing literature and case reports. Results: Patients with benign prostatic hyperplasia, vesicoureteral reflux, neurogenic bladder, nephrostomies, and ileal conduits may face increased risks of urinary tract infections, fungal colonization, and therapy-related complications due to persistent glycosuria and altered urinary flow. Nevertheless, these patients may still benefit from SGLT2i's systemic renal and cardiovascular effects. Individualized risk assessment, close monitoring, and multidisciplinary management are essential. Conclusions: Patients with urological abnormalities represent a high-risk but potentially high-reward population for SGLT2i therapy. A cautious, tailored approach is necessary, and future dedicated research is urgently needed to better guide clinical practice.

Impact of Lifestyle and the Microbiome on Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

Recent studies have facilitated a new understanding of how the microbiome and lifestyle contribute to the pathophysiology of prostatic diseases. This mini review explores evidence on the role of lifestyle, diet, and the microbiome in the development and progression of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Diet, physical activity, and the gut microbiome may influence LUTS/BPH by modulating systemic inflammation and metabolic processes. Proinflammatory diets, particularly those high in animal-based foods and low in fiber, affect systemic inflammation, leading to LUTS. Changes in the gut microbiota can alter the production of short-chain fatty acids and contribute to insulin resistance and other metabolic disturbances that may exacerbate prostate inflammation and accelerate LUTS progression. BPH development is influenced by a complex interplay of lifestyle factors, the metabolic syndrome, and the composition of the microbiota. More research into the pathophysiology of BPH is warranted to increase the evidence supporting lifestyle-based strategies in BPH prevention and management. PATIENT SUMMARY: There seems to be a link between lower urinary tract symptoms (LUTS) caused by an enlarged prostate and lifestyle, diet, and gut microbes. LUTS can be increased by factors such as a diet rich in red meat and animal protein and poor in fiber, and physical inactivity. Obesity may change the composition of microbes in the gut, which in turn increases inflammation, including in the prostate. Addressing these factors could help in preventing LUTS.

Midline-1 inhibited high glucose-induced epithelial-mesenchymal transition, fibrosis and inflammation through WNT/β-catenin signaling in benign prostatic hyperplasia

Background and objects

Benign prostatic hyperplasia (BPH) is a common disease that impairs the life quality of elderly men. The close relationship of BPH and diabetes has been generally established, however, the exact molecular mechanism remains unclear. Midline-1 (MID1) is an E3 ubiquitin ligase belonging to Tripartite Motif family and its involvement in the initiation and progression of many diseases, such as diabetic kidney disease has been well accepted. This study aims to illuminate the potential impact of high glucose (HG) on prostatic cells and elucidate the molecular role of MID1 in the development of BPH.

Methods

In this work, human prostate specimens and cultured human prostate cell lines (BPH-1 and WPMY-1) were employed. The impact of HG treatment on these two lines was assessed and the expression and localization of MID1, along with its potential downstream target protein phosphatase 2A (PP2A), were determined using multiple experimental methods. MID1-overexpressing cell models were further used to investigate the function of MID1 in regulating inflammation, fibrosis and epithelial-mesenchymal transition (EMT).

Results

Herein we demonstrate diabetic individuals with BPH had lower expression of MID1 and higher expression of the catalytic subunit of PP2A (PP2Ac), larger prostate volume, higher international prostate symptom score (IPSS) and lower Qmax than non-diabetic groups. On a cellular level, HG treatment inhibited the expression of MID1, thus stimulating cellular proliferation and triggering EMT, fibrosis and inflammation of two prostatic cells via enhanced WNT/β-catenin signaling.

Conclusions

In general, our novel data demonstrate targeting MID1 might be a promising area of medical treatment for patients with both BPH and diabetes.

Association between TyG-BMI and BPH in a national prospective cohort study

This study aims to explore the relationship between the Triglyceride Glucose Body Mass Index (TyG-BMI) and the risk of developing benign prostatic hyperplasia (BPH). Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we included 3301 men aged 45 and above. We analyzed the association between TyG-BMI and the risk of developing BPH using multivariable logistic regression and restricted cubic spline models. During the 4-year follow-up period, 268 cases of BPH were identified. There was a positive correlation between TyG-BMI and the risk of BPH (OR 1.22, 95% CI 1.08-1.38, p < 0.001), with a significant dose-response relationship (P < 0.001). Stratified analyses indicated that the impact of TyG-BMI on BPH risk was consistent across various subgroups. There is a linear positive correlation between TyG-BMI and the risk of developing BPH. Managing TyG-BMI levels may help reduce the risk of BPH.