1
|
Salazar FC, Martinez MS, Paira DA, Chocobar YA, Olivera C, Godoy GJ, Acosta-Rodriguez EV, Rivero VE, Motrich RD. CD8 T cells are dispensable for experimental autoimmune prostatitis induction and chronic pelvic pain development. Front Immunol 2024; 15:1387142. [PMID: 38807587 PMCID: PMC11130463 DOI: 10.3389/fimmu.2024.1387142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Chronic Pelvic Pain Syndrome or Chronic Prostatitis (CPPS/CP) is the most prevalent urologic affliction among young adult men. It is a challenging condition to treat, which significantly decreases patient quality of life, mostly because of its still uncertain aetiology. In that regard, an autoimmune origin is a prominent supported theory. Indeed, studies in patients and in rodent models of Experimental Autoimmune Prostatitis (EAP) have provided compelling evidence suggesting a key role of CD4 Th1 cells in disease pathogenesis. However, the implication of other prominent effectors of the immune system, such as CD8 T cells, has yet to be studied. Methods We herein analyzed the induction of prostatitis and the development of chronic pelvic pain in EAP using CD8 T cell-deficient animals. Results We found similarly elevated PA-specific immune responses, with high frequencies of specific IFNg+CD4+ and IL17+CD4+ T cells in prostate draining lymph nodes from PA-immunized either CD8 KO or wild type animals with respect to controls. Moreover, these peripheral immune responses were paralleled by the development of significant chronic pelvic pain, and accompanied by prostate histological lesions, characterized by hemorrhage, epithelial cell desquamation, marked periglandular leukocyte infiltration, and increased collagen deposition in both, PA-immunized CD8 KO and wild type animals. As expected, control animals did not develop prostate histological lesions. Discussion Our results indicate that CD8 T cells do not play a major role in EAP pathogenesis and chronic pelvic pain development. Moreover, our results corroborate the previous notion that a CD4 Th1 associated immune response drives the induction of prostate tissue inflammation and the development of chronic pelvic pain.
Collapse
Affiliation(s)
- Florencia C. Salazar
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Maria S. Martinez
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| | - Daniela A. Paira
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| | - Yair A. Chocobar
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| | - Carolina Olivera
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| | - Gloria J. Godoy
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Eva V. Acosta-Rodriguez
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
| | - Virginia E. Rivero
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| | - Ruben D. Motrich
- Centro de Investigaciones en Bioquimica Clinica e Inmunologia (CIBICI)-CONICET, Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba, Cordoba, Argentina
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence Centro de Inmunologia Clinica de Cordoba (CICC), Cordoba, Argentina
| |
Collapse
|
2
|
Franz J, Kieselbach K, Lahmann C, Gratzke C, Miernik A. Chronic Primary Pelvic Pain Syndrome in Men. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:508-518. [PMID: 36922749 PMCID: PMC10511008 DOI: 10.3238/arztebl.m2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/26/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its clinical heterogeneity and incompletely understood pathogenesis make it more difficult to treat. This article is intended to familiarize the reader with basic aspects of the manifestations, pathophysiology, diagnostic evaluation, differential diagnosis, and treatment of this condition. METHODS This article is based on relevant publications retrieved by a selective search of the literature, including the current guidelines of the European Association of Urology. The features of this disease pertaining to urology, psychosomatic medicine, and pain medicine are illuminated from an interdisciplinary perspective. RESULTS Chronic pelvic pain appears to arise through a complex interaction of inflammatory, infectious, neurological, musculoskeletal, and psychosomatic factors. A comprehensive diagnostic work-up should be carried out to evaluate and exclude the numerous differential diagnoses. Treatment strategies are based on the clinical phenotype. Randomized controlled trials have shown that significant relief can be achieved with a variety of drugs and non-pharmacological treatments, selected according to the manifestations of the condition in the individual case. Attention must be paid to treatment-specific adverse effects. CONCLUSION The management of patients with CPPPSm should consist of a comprehensive differential diagnostic evaluation and an individually oriented treatment strategy.
Collapse
Affiliation(s)
- Julia Franz
- Department of Urology, Center for Surgery at the Medical Center—University of Freiburg, Germany
| | - Kristin Kieselbach
- Medical Center—University of Freiburg, Interdisciplinary Pain Center, Freiburg, Germany
| | - Claas Lahmann
- Medical Center—University of Freiburg, Department of Psychosomatics and Psychosomatic Therapy, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Center for Surgery at the Medical Center—University of Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Center for Surgery at the Medical Center—University of Freiburg, Germany
| |
Collapse
|
3
|
Inflammation and Prostate Cancer: Pathological Analysis from Pros-IT CNR 2. Cancers (Basel) 2023; 15:cancers15030630. [PMID: 36765589 PMCID: PMC9913270 DOI: 10.3390/cancers15030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Extensive research effort has been devoted to investigating the link between inflammation and PCa. However, this relationship remains unclear and controversial. The aim of our multi-center study was to investigate this association by histologically evaluating the distribution of PI and PCA in prostate biopsy cores from patients of eight referral centers in Italy. RESULTS We evaluated 2220 cores from 197 patients; all the frustules were re-evaluated by dedicated pathologists retrospectively. Pathologists assigned IRANI scores and determined the positions of PIs; pathologists also re-evaluated the presence of PCa and relative ISUP grade. PCa was recorded in 749/2220 (33.7%). We divided this sample into a PCa PI group (634/749 cores [84.7%]) and a non-PCa + PI group (1157/1471 cores [78.7%]). We observed a statistically significant difference in the presence of inflammation among cores with cancer (p < 0.01). Moreover, periglandular inflammation was higher in the cores with neoplasia, while stromal inflammation was higher in cores without neoplasia (38.5% vs. 31.1% and 55.4% vs. 63.5% p < 0.01). CONCLUSIONS In our experience, there is evidence of an association between PI and PCa at a tissue level. Further studies are needed to confirm our findings and to identify patients who might benefit from target therapies to prevent PCa occurrence and/or progression.
Collapse
|
4
|
Schrepf A, Gallop R, Naliboff B, Harte SE, Afari N, Lai HH, Pontari M, McKernan LC, Strachan E, Kreder KJ, As-Sanie SA, Rodriguez LV, Griffith JW, Williams DA. Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. THE JOURNAL OF PAIN 2022; 23:1594-1603. [PMID: 35472518 PMCID: PMC10547025 DOI: 10.1016/j.jpain.2022.03.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0-31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. PERSPECTIVE: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
Collapse
Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Robert Gallop
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Niloofar Afari
- Department of Psychiatry, UC San Diego & VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - H Henry Lai
- Department of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Michel Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Lindsey C McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Karl J Kreder
- Departments of Urology and Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa
| | - Sawsan A As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
5
|
Hua X, Zhang J, Ge S, Liu H, Du H, Niu Q, Chen X, Yang C, Zhang L, Liang C. CXCR3 antagonist AMG487 ameliorates experimental autoimmune prostatitis by diminishing Th1 cell differentiation and inhibiting macrophage M1 phenotypic activation. Prostate 2022; 82:1223-1236. [PMID: 35700340 DOI: 10.1002/pros.24395] [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: 11/12/2021] [Revised: 04/16/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) is an inflammatory immune disease that is characterized by infiltrating inflammatory cells in the prostate and pelvic or by perineal pain. Receptor CXCR3modulates immune and inflammatory responses; however, the effects of CXCR3 antagonist AMG487 in the context of CP/CPPS are unknown. Therefore, we investigated the effect of AMG487 in experimental autoimmune prostatitis (EAP) mice and explored the potential functional mechanisms. METHODS The EAP model was induced by intradermally injecting a mixture of prostate antigens and complete Freund's adjuvant on Days 0 and 28. To evaluate the effect of AMG487 on EAP mice, treatment with AMG487 and vehicle solution was conducted for the indicated period. Then, procedures were performed, including behavioral test, to evaluate the pain response to stimulation before the mice were killed and a histological assessment to evaluate the inflammation after the mice were killed. Immunofluorescence, flow cytometry, and Western blot assay were used to analyze the functional phenotype and regulation mechanism of AMG487 on T helper type 1 (Th1) cells and macrophages. RESULTS We found high expression of CXCR3 in human benign prostate tissues with inflammation and EAP mice. The elevated CXCR3 in prostate tissues correlates with the severity of inflammation. CXCR3 antagonist AMG487 treatment ameliorated the inflammatory changes and the pelvic pain of EAP mice. AMG487 inhibits Th1 cell differentiation through the IL-12/STAT4pathway and inhibits pro-inflammatory M1 macrophages through the lipopolysaccharide/NF-κB p65signaling. AMG487 could inhibit the secretion of inflammatory mediators in EAP mice. CONCLUSION CXCR3 antagonist AMG487 could ameliorate the inflammatory changes and the pelvic pain of EAP mice by diminishing Th1 cell differentiation and inhibiting macrophage M1 phenotypic activation. Thus, the results imply that AMG487 has the potential as an effective therapeutic agent in the prevention and treatment of EAP.
Collapse
Affiliation(s)
- Xiaoliang Hua
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Jiong Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Shengdong Ge
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Haoran Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Hexi Du
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Qingsong Niu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Xianguo Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Cheng Yang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Institute of Translational Medicine, Hefei, China
| |
Collapse
|
6
|
Meng J, Jin C, Li J, Zhang S, Zhang M, Hao Z, Chen X, Song Z, Zhang L, Liang C. Metabolomics Analysis Reveals the Differential Metabolites and Establishes the Therapeutic Effect Prediction Nomogram Among CP/CPPS Patients Who Respond or Do Not Respond to LiST. Front Immunol 2022; 13:953403. [PMID: 35911714 PMCID: PMC9332892 DOI: 10.3389/fimmu.2022.953403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Low-intensity shockwave therapy (LiST) has been applied in the clinical treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but few studies have focused on the prediction of its therapeutic effect before treatment. Methods Seventy-five CP/CPPS patients from our institute between July 2020 and May 2021 were enrolled and received 3 Hz, 0.25 mJ/mm2 LiST once a week over the course of four weeks. The scores of the NIH-CPSI, IPSS questionnaire and demographic features before treatment were recorded. The plasma before LiST treatment was also collected, while liquid chromatography-tandem mass spectrometry was used to detect the metabolites. Least absolute shrinkage and selection operator (LASSO) regression analysis was employed to identify the prediction metabolites and generate the metabolism score. Receiver operating characteristic curves and calibration curves were drawn to assess the prediction accuracy of the nomogram. Results Twelve metabolites were identified at incomparable levels before and after LiST treatment. The metabolism score generated by LASSO analysis presented a perfect prediction value (AUC: 0.848, 95% CI: 0.719-0.940) in the training cohort and further increased to 0.892 (95% CI: 0.802-0.983) on the nomogram, which accompanied with the NIH-CPSI scores and age. Similar results of the metabolism score (AUC: 0.732, 95% CI: 0.516-0.889) and total nomogram (AUC: 0.968, 95% CI: 0.909-1.000) were obtained in the testing cohort. Further enrichment of the 12 metabolites indicated that the glycine and serine metabolism pathway was involved in the LiST treatment. Conclusion We used our system to accurately and quantitatively measure plasma metabolites and establish a predictive model to identify suitable patients for LiST treatment.
Collapse
Affiliation(s)
- Jialin Meng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Chen Jin
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Jiawei Li
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Song Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Meng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Xianguo Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Zhengyao Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology & Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| |
Collapse
|
7
|
Overview of seminal fluid biomarkers for the evaluation of chronic prostatitis: a scoping review. Prostate Cancer Prostatic Dis 2022; 25:627-640. [PMID: 34845305 DOI: 10.1038/s41391-021-00472-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a very common and difficult condition to evaluate, as it is a clinical diagnosis, without a measurable diagnostic "gold standard". The aim of this scoping review is to synthesize all the available data for seminal fluid biomarkers used to assess patients with CP/CPPS. METHODS A systematic search to identify all relevant publications was conducted on October 22, 2020 across five databases: Ovid Medline, Ovid EMBASE, PubMed, CCRT, and the CINAHL. Two independent authors screened all articles and extracted relevant data. RESULTS A total of 27 articles met the eligibility criteria. A majority of studies were case-control (15), with 6 observational cohorts and 6 comparative interventional studies. The total number of pooled patients included 585 patients with CP/CPPS (unspecified subtype), 371 patients with inflammatory CP/CPPS, 387 patients with non-inflammatory CP/CPPS, 354 patients with chronic bacterial prostatitis, and 432 healthy controls. Inflammatory seminal biomarkers were the most frequently studied, with IL6, IL8, TNFα and IL1β being the most promising candidates. CONCLUSIONS There are a number of very promising seminal biomarkers to help categorize and monitor therapies in CP/CPPS. Large multicentre studies using a shared protocol for measuring seminal biomarkers with the primary intention of biomarker validation are needed prior to clinical implementation. Identification of biomarker(s) will facilitate the etiological categorization of patients with chronic prostatitis and provide an objective framework to tailor specific therapies according to the biomarker family.
Collapse
|
8
|
Pattabiraman G, Liu Z, Paul M, Schaeffer AJ, Thumbikat P. mMCP7, a Mouse Ortholog of δ Tryptase, Mediates Pelvic Tactile Allodynia in a Model of Chronic Pelvic Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:805136. [PMID: 35295515 PMCID: PMC8915762 DOI: 10.3389/fpain.2021.805136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is a condition that affects a large number of men and has unknown etiology. We have previously demonstrated the presence of elevated levels of mast cell tryptase in expressed prostatic secretions (EPS) of CP/CPPS patients. In a murine model of CP/CPPS, we showed tryptase and its cognate receptor PAR2 as critical to the development of pelvic pain and lower urinary tract symptoms. Here, we extend these observations to demonstrate that an isoform of tryptase called delta (δ)-tryptase, is elevated in the EPS of patients with CP/CPPS and is correlated with pelvic pain symptoms. Using an Escherichia coli (CP1) -induced murine model of CP/CPPS, we demonstrated a differential response in C57BL/6J and NOD/ShiLtJ mice, with C57BL6/J mice being resistant to an increase in pelvic tactile allodynia, despite having equivalent levels of activated mast cells in the prostate. Activated tryptase+ve mast cells were observed to be in closer apposition to PGP9.5+ve nerve fibers in the prostate stroma of NOD/ShiLtJ in comparison to C57BL/6J mice. The mouse ortholog of δ-tryptase, mouse mast cell protease 7 (mMCP7) has been reported to be unexpressed in C57BL/6J mice. We confirmed the absence of mMCP7 in the prostates of C57BL/6J and its presence in NOD/ShiLtJ mice. To evaluate a role for mMCP7 in the differential allodynia responses, we performed direct intra-urethral instillations of mMCP7 and the beta (β)-tryptase isoform ortholog, mMCP6 in the CP1-infection model. mMCP7, but not mMCP6 was able to induce an acute pelvic allodynia response in C57BL/6J mice. In-vitro studies with mMCP7 on cultured mast cells as well as dissociated primary neurons demonstrated the ability to induce differential activation of pain and inflammation associated molecules compared to mMCP6. We conclude that mMCP7, and possibility its human ortholog δ-tryptase, may play an important role in mediating the development of pelvic tactile allodynia in the mouse model of pelvic pain and in patients with CP/CPPS.
Collapse
Affiliation(s)
| | | | | | | | - Praveen Thumbikat
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
9
|
Hua X, Ge S, Zhang M, Mo F, Zhang L, Zhang J, Yang C, Tai S, Chen X, Zhang L, Liang C. Pathogenic Roles of CXCL10 in Experimental Autoimmune Prostatitis by Modulating Macrophage Chemotaxis and Cytokine Secretion. Front Immunol 2021; 12:706027. [PMID: 34659199 PMCID: PMC8511489 DOI: 10.3389/fimmu.2021.706027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) is an inflammatory immune disease characterized by intraprostatic leukocyte infiltration and pelvic or perineal pain. Macrophages play vital roles in the pathogenesis of CP/CPPS. However, the mechanisms controlling the activation and chemotaxis of macrophages in CP/CPPS remain unclear. This study aimed to investigate the roles of the CXCL10/CXCR3 pathway in the activation and chemotaxis of macrophages in CP/CPPS patients. The serums of CP/CPPS patients and healthy volunteers were collected and measured. Results showed that CXCL10 expression was significantly elevated and correlated with the severity of CP/CPPS patients. The experimental autoimmune prostatitis (EAP) model was generated, and adeno-associated virus and CXCR3 inhibitors were used to treat EAP mice. Immunofluorescence, flow cytometry, and Western blotting were used to analyze the functional phenotype and regulation mechanism of macrophages. Results showed that CXCL10 deficiency ameliorates EAP severity by inhibiting infiltration of macrophages to prostate. Moreover, CXCL10 could induce macrophage migrations and secretions of proinflammatory mediators via CXCR3, which consequently activated the downstream Erk1/2 and p38 MAPK signaling pathways. We also showed that prostatic stromal cell is a potential source of CXCL10. Our results indicated CXCL10 as an important mediator involved in inflammatory infiltration and pain symptoms of prostatitis by promoting the migration of macrophages and secretion of inflammatory mediators via CXCR3-mediated ERK and p38 MAPK activation.
Collapse
Affiliation(s)
- Xiaoliang Hua
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Shengdong Ge
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Meng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Fan Mo
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Ligang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Jiong Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Cheng Yang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Sheng Tai
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Xianguo Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,The Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Institute of Translational Medicine, Hefei, China
| |
Collapse
|
10
|
Pena VN, Engel N, Gabrielson AT, Rabinowitz MJ, Herati AS. Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome. Drugs Aging 2021; 38:845-886. [PMID: 34586623 DOI: 10.1007/s40266-021-00890-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/29/2023]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often heterogenous condition that can have severe consequences on patient quality of life. In this review, we describe the pathophysiology, diagnostic work-up, and treatment of patients with CP/CPPS incorporating the most recent literature. Studies have demonstrated that CP/CPPS involves a complex pathophysiology, including infectious, immunologic, neurologic, endocrinologic, and psychologic etiologies, with frequent intersections between the different entities. Despite robust research assessing a variety of therapeutics targeting these etiologies, clinical trials have failed to identify an empiric treatment strategy applicable specifically to older adult male patients with CP/CPPS. As such, it can be challenging to manage older male patients with this condition. The advent of clinical phenotyping of patients with CP/CPPS has led to advances in tailored management strategies. Monomodal therapy has been largely unsuccessful because of the unclear and complex etiology of CPPS. As a result, CP/CPPS therapy has transitioned to a multimodal approach, including both pharmacologic and non-pharmacologic therapies. The best studied pharmacologic therapies include antibiotics, alpha-blockers, anti-inflammatory and immunomodulatory agents, phytotherapies, phosphodiesterase inhibitors, hormonal agents, neuromodulatory agents, and antidepressants. The best studied non-pharmacological therapies include pelvic floor physical therapy, myofascial trigger point release, acupuncture and electroacupuncture, psychological support and biofeedback, and electrocorporeal shockwave therapy and local thermotherapy.
Collapse
Affiliation(s)
- Vanessa N Pena
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Noah Engel
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Andrew T Gabrielson
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Matthew J Rabinowitz
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Amin S Herati
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
11
|
Shoskes DA, Keslar KS, Gotwald P, Berglund R, Vij S. Neuroinflammatory gene expression in chronic prostatitis/chronic pelvic pain syndrome patients: insights into etiology and phenotype biology. Transl Androl Urol 2021; 10:3340-3347. [PMID: 34532258 PMCID: PMC8421824 DOI: 10.21037/tau-21-387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/15/2021] [Indexed: 01/25/2023] Open
Abstract
Background Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has diverse clinical phenotypes and its etiology is multifactorial. Studies to date of gene expression in humans have been limited to small numbers of target genes. NanoString can simultaneously measure hundreds of genes. We wished to study gene expression in blood and urine of CP/CPPS patients compared to controls for neuroinflammatory genes and characterize the results by patient phenotype. Methods Blood and urine were collected from 10 men with CP/CPPS and 7 asymptomatic controls. RNA was isolated from urine pellets using Qiagen RNeasy kits. Whole blood was collected and RNA isolated. 100 ng of RNA was used for gene expression analysis with the 770-gene NanoString Human Neuroinflammation gene panel. Data was imported into Rosalind (OnRamp Bioinformatics) for normalization, calculation of fold-changes and P values, and identification of enriched pathways. Gene expression was considered significantly different if there was a greater than 1.5× change compared to controls and corrected P was <0.05. Results Mean patient age was 42.2 years, median symptom duration was 15.5 months, median UPOINT domains was 3 and mean total National Institute of Health-Chronic Prostatitis Symptom Index Score was 28.8. In blood, there were 5 genes with significantly different expression to controls, the largest differences found in FOS1 (neuropathic pain control), PROS1 (blood clotting) and DDX58 (antiviral innate immunity). Gene set analysis showed differences in inflammation, angiogenesis and cytokine signaling. In urine there were 48 genes with significantly different expression including SLAMF8 (lymphocyte activation) and LAIR1 (inhibits B and T cell function). Gene set analysis showed differences in carbohydrate metabolism, neurons and neurotransmission, adaptive immunity and inflammatory signaling. Subgroup analysis by UPOINT domain showed unique gene expression in the Organ Specific and Neurologic/Systemic domains in both blood and urine for neurogenic pain and cytokine signaling associated genes Conclusions Men with CP/CPPS have a diverse set of neuroinflammatory genes with differential expression compared to controls. Clinical phenotypes have distinct patterns of gene expression. These findings could lead to novel biomarker development, emphasize the importance of multimodal therapy targeting diverse pathways and further validate the biologic basic of clinical phenotyping.
Collapse
Affiliation(s)
- Daniel A Shoskes
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Karen S Keslar
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Paige Gotwald
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Vij
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
12
|
Tsunemori H, Sugimoto M. Effects of inflammatory prostatitis on the development and progression of benign prostatic hyperplasia: A literature review. Int J Urol 2021; 28:1086-1092. [PMID: 34342061 DOI: 10.1111/iju.14644] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
Benign prostatic hyperplasia is a major disease that affects the quality of life of middle-aged and older men. Although >70% of men aged >70 years have pathological benign prostatic hyperplasia, its pathogenesis and progression remain unclear. In this article, we reviewed the scientific literature on this condition and examined the development of lower urinary tract symptoms. Clinically, the weight of the prostate is not always proportional to the severity of the symptoms, and many factors can influence the progression of benign prostatic hyperplasia. Other than androgens, chronic inflammation can play an essential role in its development and the induction of symptoms, especially in symptomatic hyperplasia, because inflammatory cell infiltration is frequently observed in the prostate. Inflammation-induced changes in the prostate environment lead to changes in gene expression and subsequent chronicity of inflammation. It has been suggested that chronic asymptomatic prostatitis might be associated with changes in prostate structure and subsequent symptoms. In animal studies, the administration of anti-inflammatory drugs in rats with chronic prostatitis prevented the infiltration of inflammatory cells and increased the gland-to-stroma ratio. It is hoped that future research on the molecular biology of asymptomatic prostatitis might help to develop new therapeutic strategies for lower urinary tract symptoms associated with symptomatic prostatitis. Our conclusions provide a comprehensive insight into the prevalence and development of benign prostate hyperplasia and the treatment methods that can be used to treat it.
Collapse
Affiliation(s)
- Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| |
Collapse
|
13
|
The Clinical and Pathologic Relevance of a Prostate MRI Diagnosis of "Prostatitis". Urology 2021; 154:233-236. [PMID: 33539898 DOI: 10.1016/j.urology.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/15/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the relationship between magnetic resonance imaging evidence of prostatitis with clinical symptomatology. Non-malignant abnormalities in peripheral zone are common in prostate multiparametric prostate magnetic resonance imaging (mpMRI). These findings are sometimes reported as "prostatitis" or "inflammation" and lead to patient anxiety and urologic referral. METHODS Retrospective review of patients undergoing prostate mpMRI (2016-2017) was performed. Two cohort groups based on the presence of "prostatitis" or "inflammation" in the radiology report were identified. Clinical characteristics included age, prostate specific antigen, biopsy/intervention history, true lower urinary tract symptoms (LUTS), pain, use of urologic medications, prostate volume, and PIRADS score. Pathologic finding of inflammation was recorded. Groups were compared using chi-square for dichotomous variables and t-tests for continuous variables. RESULTS One hundred and four patients were identified with "prostatitis/inflammation" and 273 without. Report of LUTS was high in both groups (58% and 62% for prostatitis and no prostatitis respectively, P= .49), though report of moderate/severe LUTS (physician description or IPSS of 8-19 and 20+) was more common in the no prostatitis group (7% vs 18%, P= .008). Use of urologic medication was similar between the 2 groups (31% and 37% for prostatitis and no prostatitis respectively, P = .23). Biopsy finding of inflammation was more common in the prostatitis group (57% vs 43% P = .027). Reports of pelvic pain, dysuria, or urinary findings of inflammation were uncommon in both groups. CONCLUSION While mpMRI findings of prostatitis may indicate NIH Category IV prostatitis, there is no evidence of correlation with categories I, II or III prostatitis nor with symptomatic LUTS, and patients should be reassured that further investigation is not warranted.
Collapse
|
14
|
Liu Y, Wazir J, Tang M, Ullah R, Chen Y, Chen T, Zhou X. Experimental autoimmune prostatitis: different antigens induction and antigen-specific therapy. Int Urol Nephrol 2020; 53:607-618. [PMID: 33200334 DOI: 10.1007/s11255-020-02703-8] [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: 08/19/2020] [Accepted: 10/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has uncertain etiology and lacks effective treatment. Autoimmunity is an important pathogeny, and experimental autoimmune prostatitis (EAP) models have long been used for studying CP/CPPS. This review presents the detailed current knowledge of EAP models based on evaluation criteria aspects to provide a tool for model selection in pathogenesis studies and therapeutic drug screening. METHODS We extensively searched the published literature on CP/CPPS and different antigen-induced EAP models focusing on the histopathology, clinical-related phenotypes, and biochemical indicators. We also cover the changes in the prostate function and other organs in EAP. Finally, we try to get some insights about antigen-based therapeutic approaches for CP/CPPS. RESULTS Several inciting autoantigens were reported in EAP, including male accessory gland extracts, prostate extracts (PE), prostatic steroid-binding protein, prostatic spermine-binding protein (p25), prostatic acid phosphatase, seminal vesicle secretory protein 2, and T2 peptide. All of these models mimicked histological prostatitis, however only p25- and T2-induced models developed both pelvic pain and voiding behaviors. PE immunization is the most widely used method. Diminished fertility and mental health disorders can be found in PE model. Oral and intravenous T2 peptide have been studied for antigen-specific therapy and achieved preliminary progress in EAP models. CONCLUSIONS PE-induced model is the most commonly used, while T2- or p25-model could serve as a promising CP/CPPS model. Antigen-specific therapy in CP/CPPS deserves further study.
Collapse
Affiliation(s)
- Yuqian Liu
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Junaid Wazir
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Meng Tang
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Rahat Ullah
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Yueting Chen
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Tingting Chen
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Xiaohui Zhou
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China. .,Department of Surgery, Nanjing Shuiximen Hospital, Nanjing, 210017, Jiangsu, People's Republic of China.
| |
Collapse
|
15
|
Aljohani OS. Phytochemical evaluation of Cucumis prophetarum: protective effects against carrageenan-induced prostatitis in rats. Drug Chem Toxicol 2020; 45:1461-1469. [PMID: 33092416 DOI: 10.1080/01480545.2020.1838538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Phytochemical study of the MeOH extract of Cucumis prophetarum fruits (family Cucurbitaceae) by using different chromatographic techniques led to the isolation of three metabolites; spinasterol (1), cucurbitacin B (2), and 2-O-β-D-glucopyranosylcucurbitacin E (3). Their chemical structures were created on the basis of physical, chemical, spectroscopic data 1D (1H and 13C NMR), and 2D NMR (HSQC and HMBC), as well as similarity with literature data. Cucurbitacin B (Cu-B) (2) was found to be the major constituent. Potential protective activities of MeOH extract, CHCl3, and EtOAc fractions and Cu-B were evaluated against carrageenan-induced prostatic inflammation in rats. Acute toxicity was assessed by evaluating LD50. Pretreatment with CHCl3 fraction and Cu-B ameliorated the rise in the prostate index and obviously protected against histopathological changes. Further, MeOH, extract, CHCl3, and EtOAc fractions as well as Cu-B significantly protected against oxidative stress in prostatic tissues. The anti-inflammatory activities of the extract, fractions and Cu-B were confirmed by ameliorating the rise in prostatic content of the inflammatory mediators TNF-α, IL-1β, COX-2, and iNOS induced by carrageenan. In addition, the rise in the chemotactic factors were myeloperoxidase (MPO), F4-80, and monocyte chemoattractant protein-1 (MCP-1) was significantly hampered. In conclusion, three known compounds (1-3) were isolated from Cucumis prophetarum fruits. Cu-B (2) was the major identified compound. Particularly, CHCl3 fraction and isolated Cu-B exhibited potent anti-inflammatory activity against carrageenan-induced prostatitis. The anti-inflammatory activity can be attributed, at least partly, to inhibition of neutrophil and macrophage infiltration into prostatic tissues.
Collapse
Affiliation(s)
- Omar Saad Aljohani
- Faculty of Pharmacy, Department of Natural Products and Alternative Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
16
|
Zhang L, Liu Y, Chen XG, Zhang Y, Chen J, Hao ZY, Fan S, Zhang LG, Du HX, Liang CZ. MicroRNA expression profile in chronic nonbacterial prostatitis revealed by next-generation small RNA sequencing. Asian J Androl 2020; 21:351-359. [PMID: 30604696 PMCID: PMC6628738 DOI: 10.4103/aja.aja_97_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRNAs) are considered to be involved in the pathogenic initiation and progression of chronic nonbacterial prostatitis (CNP); however, the comprehensive expression profile of dysregulated miRNAs, relevant signaling pathways, and core machineries in CNP have not been fully elucidated. In the current research, CNP rat models were established through the intraprostatic injection of carrageenan into the prostate. Then, next-generation sequencing was performed to explore the miRNA expression profile in CNP. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) bioinformatical analyses were conducted to reveal the enriched biological processes, molecular functions, and cellular components and signaling pathways. As a result, 1224, 1039, and 1029 known miRNAs were annotated in prostate tissues from the blank control (BC), normal saline injection (NS), and carrageenan injection (CAR) groups (n = 3 for each group), respectively. Among them, 84 miRNAs (CAR vs BC) and 70 miRNAs (CAR vs NS) with significantly different expression levels were identified. Compared with previously reported miRNAs with altered expression in various inflammatory diseases, the majority of deregulated miRNAs in CNP, such as miR-146b-5p, miR-155-5p, miR-150-5p, and miR-139-5p, showed similar expression patterns. Moreover, bioinformatics analyses have enriched mitogen-activated protein kinase (MAPK), cyclic adenosine monophosphate (cAMP), endocytosis, mammalian target of rapamycin (mTOR), and forkhead box O (FoxO) signaling pathways. These pathways were all involved in immune response, which indicates the critical regulatory role of the immune system in CNP initiation and progression. Our investigation has presented a global view of the differentially expressed miRNAs and potential regulatory networks containing their target genes, which may be helpful for identifying the novel mechanisms of miRNAs in immune regulation and effective target-specific theragnosis for CNP.
Collapse
Affiliation(s)
- Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Yi Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Xian-Guo Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Yong Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jing Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Zong-Yao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Song Fan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| | - Li-Gang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - He-Xi Du
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Institute of Urology, Anhui Medical University, Hefei 230022, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei 230022, China
| |
Collapse
|
17
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Tirapegui FI, Garrote V, Vietto V. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2019; 10:CD012552. [PMID: 31587256 PMCID: PMC6778620 DOI: 10.1002/14651858.cd012552.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. We considered a 25% decrease of NIH-CPSI baseline score or a six-point reduction as MCID. OBJECTIVES To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome. SEARCH METHODS We performed a comprehensive search using CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, trial registries, grey literature and conference proceedings, with no restrictions on the language of publication or publication status. The date of the latest search of all databases was July 2019. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available pharmacological interventions compared to placebo or in head-to-head comparisons. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed the risks of bias of included studies. We assessed the quality of the evidence (QoE) using the GRADE approach. MAIN RESULTS We included 99 unique studies in 9119 men with CP/CPPS, with assessments of 16 types of pharmacological interventions. Unless stated otherwise, our comparisons were based on short-term follow-up (less than 12 months). Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies.1. Alpha blockers: (24 studies, 2061 participants). We are uncertain about the effects of these drugs on prostatitis symptoms when compared to placebo at short-term follow-up (mean difference (MD) in total NIH-CPSI score -5.01, 95% confidence interval (CI) -7.41 to -2.61; 18 studies, 1524 participants, very low QoE) and at long-term follow-up (MD -5.60, 95% CI -10.89 to -0.32; 4 studies, 235 participants, very low QoE). Alpha blockers may be associated with an increased incidence of adverse events, such as dizziness and postural hypotension (risk ratio (RR) 1.60, 95% CI 1.09 to 2.34; 19 studies, 1588 participants; low QoE). Alpha blockers probably result in little to no difference in sexual dysfunction, quality of life and anxiety and depression (moderate to low QoE).2. 5-alpha reductase inhibitors (5-ARI): (2 studies, 177 participants). Finasteride probably reduces prostatitis symptoms compared to placebo (NIH-CPSI score MD -4.60, 95% CI -5.43 to -3.77; 1 study, 64 participants; moderate QoE) and may not be associated with an increased incidence of adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.3. Antibiotics: (6 studies, 693 participants). Antibiotics (quinolones) may reduce prostatitis symptoms compared to placebo (NIH-CPSI score MD -2.43, 95% CI -4.72 to -0.15; 5 studies, 372 participants; low QoE) and are probably not associated with an increased incidence in adverse events (moderate QoE). Antibiotics probably result in little to no difference in sexual dysfunction and quality of life (moderate QoE). There was no information on anxiety or depression.4. Anti-inflammatories: (7 studies, 585 participants). Anti-inflammatories may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -2.50, 95% CI -3.74 to -1.26; 7 studies, 585 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.5. Phytotherapy: (7 studies, 551 participants). Phytotherapy may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -5.02, 95% CI -6.81 to -3.23; 5 studies, 320 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). Phytotherapy may not improve sexual dysfunction (low QoE). There was no information on quality of life or anxiety and depression.6. Botulinum toxin A (BTA): Intraprostatic BTA injection (1 study, 60 participants) may cause a large reduction in prostatitis symptom (NIH-CPSI scores MD -25.80, 95% CI -30.15 to -21.45), whereas pelvic floor muscle BTA injection (1 study, 29 participants) may not reduce prostatitis symptoms (low QoE). Both comparisons used a placebo injection. These interventions may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.7. Allopurinol: (2 studies, 110 participants). Allopurinol may result in little to no difference in prostatitis symptoms and adverse events when compared to placebo (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.8. Traditional Chinese medicine (TCM): (7 studies, 835 participants); TCM may reduce prostatitis symptoms (NIH-CPSI score, MD -3.13, 95% CI -4.99 to -1.28; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). TCM probably does not improve sexual dysfunction (moderate QoE) and may not improve symptoms of anxiety and depression (low QoE). There was no information on quality of life.The most frequent reasons for downgrading the QoE were study limitations, inconsistency and imprecision. We found few trials with active comparators. AUTHORS' CONCLUSIONS We found low- to very low-quality evidence that alpha blockers, antibiotics, 5-ARI, anti-inflammatories, phytotherapy, intraprostatic BTA injection, and traditional Chinese medicine may cause a reduction in prostatitis symptoms without an increased incidence of adverse events in the short term, except for alpha blockers which may be associated with an increase in mild adverse events. We found few trials with active comparators and little evidence of the effects of these drugs on sexual dysfunction, quality of life or anxiety and depression. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes, including potential treatment-related adverse events, and appropriate sample sizes.
Collapse
Affiliation(s)
- Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | | | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos AiresUrology DivisionJuan D. Peron 4190Ciudad Autónoma de Buenos AiresBuenos AiresArgentinaC1181ACH
| | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceBuenos AiresArgentina
| | | |
Collapse
|
18
|
Cai T, Santi R, Tamanini I, Galli IC, Perletti G, Bjerklund Johansen TE, Nesi G. Current Knowledge of the Potential Links between Inflammation and Prostate Cancer. Int J Mol Sci 2019; 20:ijms20153833. [PMID: 31390729 PMCID: PMC6696519 DOI: 10.3390/ijms20153833] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023] Open
Abstract
Inflammation is inherent in prostatic diseases and it is now accepted that it may facilitate cellular proliferation in both benign and malignant conditions. The strong relationship between prostatic inflammation and pathogenesis of benign prostatic hyperplasia (BPH) is supported by epidemiologic, histopathologic and molecular evidence. Contrariwise, the role of inflammation in prostate carcinogenesis is still controversial, although current data indicate that the inflammatory microenvironment can regulate prostate cancer (PCa) growth and progression. Knowledge of the complex molecular landscape associated with chronic inflammation in the context of PCa may lead to the introduction and optimization of novel targeted therapies. In this perspective, evaluation of the inflammatory component in prostate specimens could be included in routine pathology reports.
Collapse
Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | | | - Irene Tamanini
- Department of Urology, Santa Chiara Regional Hospital, 38122 Trento, Italy
| | | | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, 21100 Busto Arsizio, Italy
| | | | - Gabriella Nesi
- Department of Health Sciences, University of Florence, 50139 Florence, Italy.
| |
Collapse
|
19
|
Ashok A, Keener R, Rubenstein M, Stookey S, Bajpai S, Hicks J, Alme AK, Drake CG, Zheng Q, Trabzonlu L, Yegnasubramanian S, De Marzo AM, Bieberich CJ. Consequences of interleukin 1β-triggered chronic inflammation in the mouse prostate gland: Altered architecture associated with prolonged CD4 + infiltration mimics human proliferative inflammatory atrophy. Prostate 2019; 79:732-745. [PMID: 30900284 DOI: 10.1002/pros.23784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Elevated expression of the proinflammatory cytokine interleukin 1β (IL-1β) has been observed in expressed prostatic secretions of patients with chronic prostatitis/chronic pelvic pain syndrome, and genetic polymorphisms associated with the IL1B gene are linked to increased risk for aggressive prostate cancer. METHODS To study the role of IL-1β expression in prostate inflammation, we examined IL1B expression in human prostatic proliferative inflammatory atrophy (PIA) lesions and developed a tetracycline-regulated human IL1B transgene in the mouse prostate. RESULTS Here, we demonstrate that IL1B expression is a common finding in human PIA lesions, which harbored focal IL1B expression in epithelial and stromal compartments. Human IL1B expression in the mouse prostate elicited acute and chronic inflammation. Penetrance and expressivity were variable and tunable by altering transgene dosage and the presence of an exogenous inducible marker antigen (green fluorescent protein). Inflammation was characterized by infiltration of CD4+ T cells, demonstrating an adaptive immune response. Chronic inflammation persisted after doxycycline (Dox) withdrawal. Reactive epithelia increased expression of downstream cytokines, and altered glandular architecture was observed upon sustained induction of IL1B. Immunohistochemical analyses revealed a higher proliferative index and decreased Nkx3.1 expression in inflamed mouse prostates. CONCLUSIONS These data implicate IL-1β in human prostate pathology and this model provides a versatile platform to interrogate molecular mechanisms of inflammation-associated prostate pathologies associated with episodic or sustained IL-1β expression.
Collapse
Affiliation(s)
- Arya Ashok
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
| | - Rebecca Keener
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
| | - Michael Rubenstein
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
| | - Stephanie Stookey
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
| | - Sagar Bajpai
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
| | - Jessica Hicks
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Angela K Alme
- Department of Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles G Drake
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Qizhi Zheng
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Levent Trabzonlu
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Srinivasan Yegnasubramanian
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Angelo M De Marzo
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles J Bieberich
- Department of Biological Sciences, University of Maryland, Baltimore, Maryland
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
| |
Collapse
|
20
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018; 5:CD012551. [PMID: 29757454 PMCID: PMC6494451 DOI: 10.1002/14651858.cd012551.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may not reduce sexual dysfunction when compared with sham procedure (MD in the International Index of Erectile Function (IIEF) Scale -0.50, 95% CI -3.46 to 2.46, low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). We found no information regarding quality of life, depression or anxiety.2. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.3. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). This programme may not reduce anxiety or depression (low QoE). We found no information regarding adverse events, sexual dysfunction or quality of life.4. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.5. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). This treatment probably improves sexual dysfunction (MD in the IIEF Scale MD 3.34, 95% CI 2.68 to 4.00, one study, 60 participants, moderate QoE). We found no information regarding quality of life, depression or anxiety.6. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. We found no information regarding sexual dysfunction, quality of life, depression or anxiety.7. Other interventions: there is uncertainty about the effects of most of the other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Collapse
Affiliation(s)
- Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceTte. Gral. Juan Domingo Perón 4190Buenos AiresBuenos AiresArgentinaC1199ABB
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | | | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | - Valeria Vietto
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceTte. Gral. Juan Domingo Perón 4190Buenos AiresBuenos AiresArgentinaC1199ABB
| | | |
Collapse
|
21
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018; 1:CD012551. [PMID: 29372565 PMCID: PMC6491290 DOI: 10.1002/14651858.cd012551.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture likely results in little to no difference in adverse events (moderate QoE). It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, moderate QoE).2. Circumcision: (one study, 713 participants) based on short-term follow-up, early circumcision probably decreases prostatitis symptoms slightly (NIH-CPSI score MD -3.00, 95% CI -3.82 to -2.18, moderate QoE) and may not be associated with a greater incidence of adverse events compared with control (a waiting list to be circumcised, low QoE).3. Electromagnetic chair: (two studies, 57 participants) based on short-term follow-up, we are uncertain of the effects of the use of an electromagnetic chair on prostatitis symptoms. It may be associated with a greater incidence of adverse events compared with sham procedure (low to very low QoE).4. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events.5. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). We found no information regarding adverse events.6. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events.7. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE).8. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events.9. Other interventions: there is uncertainty about the effects of other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS Some of the interventions can decrease prostatitis symptoms in an appreciable number without a greater incidence of adverse events. The QoE was mostly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Collapse
Affiliation(s)
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | | | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | - Stanislav Iakhno
- Norwegian University of Life SciencesFood Safety and Infection Biology (Matinf)OsloNorway
| | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | | |
Collapse
|
22
|
Huang TR, Li W, Peng B. Correlation of inflammatory mediators in prostatic secretion with chronic prostatitis and chronic pelvic pain syndrome. Andrologia 2017; 50. [PMID: 28762547 DOI: 10.1111/and.12860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 01/15/2023] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common clinical syndrome, and the mechanisms underlying the relationship between CP/CPPS and ED are still unclear. This study aimed to investigate the differential expression of 40 inflammatory mediators in patients with CP/CPPS and to demonstrate whether these mediators related to the severity of erectile function. Eighty cases of patients with CP/CPPS were selected, including 40 cases of IIIA and 40 cases of IIIB, with 20 cases of healthy men as controls. After collecting their expressed prostatic secretion, cytokines levels in EPS were determined by ELISA using ELISA kits. The IIEF-5 questionnaire was used to evaluate erectile function. IIEF-5 scores were significantly lower in the IIIA and IIIB groups than those in the control group. The expression of IL-8, IL-1β and ICAM-1 was markedly higher in the IIIA and IIIB groups than in the control group. The expression of IL-8, IL-1β and ICAM-1 in the IIIA group was higher than that in the IIIB group. The expression of IL-8, IL-1β and ICAM-1 was negatively correlated with IIEF-5 scores in both IIIA and IIIB patients. In conclusion, IL-8, IL-1β and ICAM-1 are possible indicators for the clinical diagnosis of CP/CPPS and evaluation of erectile function on patients with CP/CPPS.
Collapse
Affiliation(s)
- T R Huang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - W Li
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - B Peng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
23
|
Breser ML, Salazar FC, Rivero VE, Motrich RD. Immunological Mechanisms Underlying Chronic Pelvic Pain and Prostate Inflammation in Chronic Pelvic Pain Syndrome. Front Immunol 2017; 8:898. [PMID: 28824626 PMCID: PMC5535188 DOI: 10.3389/fimmu.2017.00898] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 07/13/2017] [Indexed: 12/12/2022] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common urologic morbidity in men younger than 50 years and is characterized by a diverse range of pain and inflammatory symptoms, both in type and severity, that involve the region of the pelvis, perineum, scrotum, rectum, testes, penis, and lower back. In most patients, pain is accompanied by inflammation in the absence of an invading infectious agent. Since CP/CPPS etiology is still not well established, available therapeutic options for patients are far from satisfactory for either physicians or patients. During the past two decades, chronic inflammation has been deeply explored as the cause of CP/CPPS. In this review article, we summarize the current knowledge regarding immunological mechanisms underlying chronic pelvic pain and prostate inflammation in CP/CPPS. Cumulative evidence obtained from both human disease and animal models indicate that several factors may trigger chronic inflammation in the form of autoimmunity against prostate, fostering chronic prostate recruitment of Th1 cells, and different other leukocytes, including mast cells, which might be the main actors in the consequent development of chronic pelvic pain. Thus, the local inflammatory milieu and the secretion of inflammatory mediators may induce neural sensitization leading to chronic pelvic pain development. Although scientific advances are encouraging, additional studies are urgently needed to establish the relationship between prostatitis development, mast cell recruitment to the prostate, and the precise mechanisms by which they would induce pelvic pain.
Collapse
Affiliation(s)
- María L Breser
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Florencia C Salazar
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Viginia E Rivero
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Rubén D Motrich
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| |
Collapse
|
24
|
Franco JVA, Tirapegui FI, Turk T, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Hippokratia 2017. [DOI: 10.1002/14651858.cd012551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Juan VA Franco
- Instituto Universitario del Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Buenos Aires Argentina C1199ACL
| | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos Aires; Urology Division; Juan D. Peron 4190 Ciudad Autónoma de Buenos Aires Buenos Aires Argentina C1181ACH
| | - Tarek Turk
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Virginia Garrote
- Instituto Universitario Hospital Italiano; Biblioteca Central; J.D. Perón 4190 Buenos Aires Argentina C1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos Aires; Family and Community Medicine Service; Buenos Aires Argentina
| |
Collapse
|
25
|
Franco JVA, Tirapegui FI, Turk T, Garrote V, Vietto V. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Hippokratia 2017. [DOI: 10.1002/14651858.cd012552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Juan VA Franco
- Instituto Universitario del Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Buenos Aires Argentina C1199ACL
| | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos Aires; Urology Division; Juan D. Peron 4190 Ciudad Autónoma de Buenos Aires Buenos Aires Argentina C1181ACH
| | - Tarek Turk
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Virginia Garrote
- Instituto Universitario Hospital Italiano; Biblioteca Central; J.D. Perón 4190 Buenos Aires Argentina C1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos Aires; Family and Community Medicine Service; Buenos Aires Argentina
| |
Collapse
|
26
|
Chronic Prostate Inflammation Predicts Symptom Progression in Patients with Chronic Prostatitis/Chronic Pelvic Pain. J Urol 2017; 198:122-128. [PMID: 28089730 DOI: 10.1016/j.juro.2017.01.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE We examined the 4-year longitudinal association between histological prostate inflammation and chronic prostatitis/chronic pelvic pain syndrome. We also studied the development of new and progressing existing chronic prostatitis/chronic pelvic pain syndrome in men randomized to placebo in the REDUCE (REduction by DUtasteride of prostate Cancer Events) population. MATERIALS AND METHODS At multiple time points during 4 years univariable and multivariable analyses were performed between acute and chronic inflammation detected on baseline biopsies and the incidence of chronic pelvic pain syndrome-like symptoms, defined as a positive response to CPSI (Chronic Prostatitis Symptom Index) question 1a-perineal pain and/or question 2b-ejaculatory pain and a total pain subscore of at least 4, and progression of chronic prostatitis/chronic pelvic pain syndrome, defined as a 4-point or greater increase from baseline in total CPSI score, in patients with a baseline categorization of chronic prostatitis/chronic pelvic pain syndrome. RESULTS Of the 4,109 men in the study acute and chronic inflammation was detected in 641 (15.6%) and 3,216 (78.3%), respectively. Chronic prostatitis/chronic pelvic pain syndrome symptom status was available for 2,816 at baseline. Chronic prostatitis/chronic pelvic pain syndrome-like symptoms developed in 317 of 2,150 men without the condition at baseline who had followup data. Acute and chronic inflammation was not associated with the incidence of the symptoms (p >0.1). At a median followup of 12.0 months 109 of 145 men with baseline chronic prostatitis/chronic pelvic pain syndrome and followup data showed symptomatic progression. Chronic but not acute inflammation was significantly associated with shorter time to progression on univariable and multivariable analyses (p = 0.029 and 0.018, respectively). CONCLUSIONS Inflammation is not associated with an increased risk of chronic prostatitis/chronic pelvic pain syndrome. However, chronic inflammation predicts the risk of symptomatic progression in men in whom chronic prostatitis/chronic pelvic pain syndrome symptoms have been identified.
Collapse
|
27
|
Abstract
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
Collapse
Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tae Hee Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
28
|
Franco JVA, Tirapegui FI, Garrote V, Vietto V. Interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd012320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Juan VA Franco
- Instituto Universitario del Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Buenos Aires Argentina C1199ACL
| | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos Aires; Urology Division; Juan D. Peron 4190 Ciudad Autónoma de Buenos Aires Buenos Aires Argentina C1181ACH
| | - Virginia Garrote
- Instituto Universitario Hospital Italiano; Biblioteca Central; J.D. Perón 4190 Buenos Aires Argentina C1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos Aires; Family and Community Medicine Service; Buenos Aires Argentina
| |
Collapse
|
29
|
Fujimoto K, Yoshino T, Yoshioka K, Yuyama H, Masuda N, Takeda M. Intratesticular Bradykinin Involvement in Rat Testicular Pain Models. Low Urin Tract Symptoms 2016; 10:101-105. [PMID: 27167873 DOI: 10.1111/luts.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 01/31/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To clarify the role of bradykinin in urogenital pain, we investigated bradykinin involvement in rat models of testicular pain. METHODS Bradykinin (0.1, 0.3, 1, 3 and 10 mmol/L) or distilled water was injected into the testes of male Wistar rats, and induced pain behaviors in conscious rats were evaluated. The effect of pretreatment with bradykinin B2 receptor antagonist FK3657 on bradykinin-induced pain behavior was then examined. We also evaluated the analgesic effect of FK3657 in a rat acetic acid-induced testicular pain as well as changes in the intratesticular bradykinin concentration after testicular injection of acetic acid. RESULTS An injection of bradykinin into the testes of conscious rats induced pain behaviors that were dose-proportionally reduced by prior administration of FK3657. In addition, FK3657 dose-dependently inhibited the pain responses induced by testicular injection of 1% acetic acid. An increase in intratesticular bradykinin concentration was detected after the testicular injection of 1% acetic acid. CONCLUSIONS Here, we found that intratesticular bradykinin evokes pain behavior via stimulation of bradykinin B2 receptors and that intratesticular acetic acid injection induces intratesticular bradykinin synthesis, consequently leading to pain behavior. These findings suggest that the potential utility of bradykinin B2 receptor antagonists as a novel target for treating urogenital pain.
Collapse
Affiliation(s)
| | - Taiji Yoshino
- Drug Discovery Research, Astellas Pharma Inc., Tsukuba, Japan
| | | | - Hironori Yuyama
- Drug Discovery Research, Astellas Pharma Inc., Tsukuba, Japan
| | - Noriyuki Masuda
- Drug Discovery Research, Astellas Pharma Inc., Tsukuba, Japan
| | - Masahiro Takeda
- Drug Discovery Research, Astellas Pharma Inc., Tsukuba, Japan
| |
Collapse
|
30
|
Hu J, Zhang L, Zou L, Hu M, Fan J, Cai Y, Xu G, Fang J, Ding Q, Jiang H. Role of inflammation in benign prostatic hyperplasia development among Han Chinese: A population-based and single-institutional analysis. Int J Urol 2015; 22:1138-42. [PMID: 26311564 DOI: 10.1111/iju.12914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jimeng Hu
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Limin Zhang
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Lujia Zou
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Mengbo Hu
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Jie Fan
- Department of Pathology; Huashan Hospital; Fudan University; Shanghai China
| | - Yehua Cai
- Department of Ultrasound; Huashan Hospital; Fudan University; Shanghai China
| | - Gang Xu
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Jie Fang
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Qiang Ding
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| | - Haowen Jiang
- Department of Urology; Huashan Hospital; Fudan University; Shanghai China
| |
Collapse
|
31
|
Potts JM. Male Pelvic Pain Syndrome: Escaping the Snare of Prostatocentric Thinking. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Burcham GN, Cresswell GM, Snyder PW, Chen L, Liu X, Crist SA, Henry MD, Ratliff TL. Impact of prostate inflammation on lesion development in the POET3(+)Pten(+/-) mouse model of prostate carcinogenesis. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:3176-91. [PMID: 25455686 DOI: 10.1016/j.ajpath.2014.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/14/2014] [Accepted: 08/20/2014] [Indexed: 12/12/2022]
Abstract
Evidence linking prostatitis and prostate cancer development is contradictory. To study this link, the POET3 mouse, an inducible model of prostatitis, was crossed with a Pten-loss model of prostate cancer (Pten(+/-)) containing the ROSA26 luciferase allele to monitor prostate size. Prostatitis was induced, and prostate bioluminescence was tracked over 12 months, with lesion development, inflammation, and cytokine expression analyzed at 4, 8, and 12 months and compared with mice without induction of prostatitis. Acute prostatitis led to more proliferative epithelium and enhanced bioluminescence. However, 4 months after initiation of prostatitis, mice with induced inflammation had lower grade pre-neoplastic lesions. A trend existed toward greater development of carcinoma 12 months after induction of inflammation, including one of two mice with carcinoma developing perineural invasion. Two of 18 mice at the later time points developed lesions with similarities to proliferative inflammatory atrophy, including one mouse with associated carcinoma. Pten(+/-) mice developed spontaneous inflammation, and prostatitis was similar among groups of mice at 8 and 12 months. Analyzed as one cohort, lesion number and grade were positively correlated with prostatitis. Specifically, amounts of CD11b(+)Gr1(+) cells were correlated with lesion development. These results support the hypothesis that myeloid-based inflammation is associated with lesion development in the murine prostate, and previous bouts of CD8-driven prostatitis may promote invasion in the Pten(+/-) model of cancer.
Collapse
Affiliation(s)
- Grant N Burcham
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana; Heeke Animal Disease Diagnostic Laboratory, Southern Indiana Purdue Agricultural Center, Dubois, Indiana
| | - Gregory M Cresswell
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Paul W Snyder
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana; Purdue University Center for Cancer Research, West Lafayette, Indiana
| | - Long Chen
- Department of Biochemistry, College of Agriculture, Purdue University, West Lafayette, Indiana
| | - Xiaoqi Liu
- Department of Biochemistry, College of Agriculture, Purdue University, West Lafayette, Indiana; Purdue University Center for Cancer Research, West Lafayette, Indiana
| | - Scott A Crist
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana; Purdue University Center for Cancer Research, West Lafayette, Indiana
| | - Michael D Henry
- Department of Physiology and Biophysics and Holden Comprehensive Cancer Center, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Timothy L Ratliff
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana; Purdue University Center for Cancer Research, West Lafayette, Indiana.
| |
Collapse
|
33
|
Park JJ, Roudier MP, Soman D, Mokadam NA, Simkin PA. Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study. BMJ Open 2014; 4:e005308. [PMID: 25031195 PMCID: PMC4120371 DOI: 10.1136/bmjopen-2014-005308] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/30/2014] [Accepted: 06/25/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The prevalence of urate crystals in residual tissue samples from coronary arteries, aortic valves and prostate glands was assessed. METHODS Alcohol-fixed coronary arteries from 55 explanted hearts, alcohol-fixed aortic valves collected from 75 valve replacement surgeries and 40 frozen, unfixed prostate specimens resected during cancer surgery were examined for birefringent crystals with polarising microscopy. RESULTS In the 55 explanted hearts, 6 (10.9%) contained a coronary artery with birefringent crystals. One of the 75 aortic valves (1.4%) contained negatively and positively birefringent crystals. Nineteen of the 40 (47.5%) prostates contained birefringent crystals. CONCLUSIONS We found that a remarkable percentage of coronary arteries and prostate specimens contained birefringent crystals. Crystal presence is an obvious prerequisite for possible crystal induced-inflammation in these tissues, just as similar crystals elicit a gouty inflammatory cascade in synovial joints. Further studies are necessary to determine whether urate crystals may play this role in these tissues and, if so, to establish whether urate-lowering therapy may be beneficial in prostatitis and coronary disease.
Collapse
Affiliation(s)
- Jane J Park
- Department of Medicine (Rheumatology), University of Washington, Seattle, Washington, USA
| | | | - Divya Soman
- Department of Medicine (Rheumatology), University of Washington, Seattle, Washington, USA
| | - Nahush A Mokadam
- Department of Surgery (Cardiothoracic Surgery), University of Washington, Seattle, Washington, USA
| | - Peter A Simkin
- Department of Medicine (Rheumatology), University of Washington, Seattle, Washington, USA
| |
Collapse
|
34
|
Abstract
The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease.
Collapse
|
35
|
Pontari MA. Editorial comment. Urology 2014; 83:526-7; discussion 527. [PMID: 24581513 DOI: 10.1016/j.urology.2013.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
36
|
Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection? World J Urol 2013; 31:725-32. [PMID: 23579440 DOI: 10.1007/s00345-013-1061-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/15/2013] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To review the etiology and pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS A literature review for the years 1985-2012 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS The evidence for ongoing infection in men with CP/CPPS is lacking. However, men with CP/CPPS are twice as likely to have had a sexually transmitted disease (STD), and bacteria from men with CP/CPPS may be phenotypically different from those that cause cystitis or acute prostatitis. Evidence continues to support an alteration in both the afferent and efferent autonomic nervous systems. Functional brain imaging suggests changes in the gray matter as well as the importance of the anterior insula and anterior cingulated gyrus in pain processing. Neural function can be modulated by immune and endocrine factors. Alterations in cytokine function and autoimmunity appear to play a role in the immune dysfunction. Alterations in the hypothalamic-pituitary-adrenal axis can mediate the endocrine effects, similar to many other chronic pain conditions. Genetics may play a role in who may develop chronic pain after an initial insult. Finally, any biological changes must then be processed through the psychosocial environment, including the tendency to catastrophize, and degree of spousal support, to produce a given individual patient's pain experience. CONCLUSIONS Infection with atypical bacteria or sequelae of an STD may lead to CP/CPPS in some men. Such a biological insult in the context of alterations in psychoimmunoneurendocrine factors produces the chronic pain experience.
Collapse
|
37
|
Mi H, Gao Y, Yan Y, Wu Y, Tan A, Yang X, Zhang H, Zhang Y, Lv W, Mo Z. Research of Correlation Between the Amount of Leukocyte in EPS and NIH-CPSI: Result From 1242 Men in Fangchenggang Area in Guangxi Province. Urology 2012; 79:403-8. [DOI: 10.1016/j.urology.2011.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/13/2011] [Accepted: 09/20/2011] [Indexed: 10/15/2022]
|
38
|
Doluoglu OG, Gokkaya CS, Aktas BK, Oztekin CV, Bulut S, Memis A, Cetinkaya M. Impact of asymptomatic prostatitis on re-operations due to urethral stricture or bladder neck contracture developed after TUR-P. Int Urol Nephrol 2012; 44:1085-90. [DOI: 10.1007/s11255-012-0127-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 01/09/2012] [Indexed: 12/31/2022]
|
39
|
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common male pain condition that is associated with significant discomfort and disability. Despite significant efforts, there remains no definitive etiology or treatment of the spectrum of pelvic symptoms reported by these patients. The purpose of this review is to summarize important clinical and scientific findings related to CP/CPPS from the previous 2 years, and to evaluate their impact on our understanding of, and approach to, the disease.
Collapse
Affiliation(s)
- Katy S Konkle
- Department of Urology, University of Michigan Medical Center, Ann Arbor, USA
| | | |
Collapse
|
40
|
|
41
|
Prostate secretions from men with chronic pelvic pain syndrome inhibit proinflammatory mediators. J Urol 2010; 184:1536-42. [PMID: 20723928 DOI: 10.1016/j.juro.2010.05.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE In the past numerous chemokines have been noted in the expressed prostatic secretions of patients with chronic prostatitis/chronic pelvic pain syndrome. We examined the functional effects of chemokines in expressed prostatic secretions of patients with chronic pelvic pain syndrome. MATERIALS AND METHODS We studied the functional effects of expressed prostatic secretions on human monocytes by examining monocyte chemotaxis in response to monocyte chemoattractant protein-1, a major chemoattractant previously identified in chronic prostatitis/chronic pelvic pain syndrome cases. We determined effects on cellular signaling by quantifying intracellular calcium increase in monocytes and nuclear factor-κB activation in normal prostate epithelial cells. RESULTS Results show that the monocyte chemoattractant protein-1 in expressed prostatic secretions is nonfunctional with an inability to mediate human monocyte chemotaxis, or mediate signaling in monocytes or prostate epithelial cells. This lack of functionality could be extended to other proinflammatory cytokines, such as interleukin-1β and tumor necrosis factor-α, when incubated with expressed prostatic secretions from patients with chronic pelvic pain syndrome. The mechanism underlying this apparent ability to modulate proinflammatory cytokines involves heat labile extracellular proteases that mediate the inhibition of immune and prostate epithelial cell function. CONCLUSIONS These results may have implications for the design of specific diagnostic and therapeutic methods targeted toward the complete resolution of prostate inflammatory insults.
Collapse
|
42
|
Prostatitis, sexually transmitted diseases, and prostate cancer: the California Men's Health Study. PLoS One 2010; 5:e8736. [PMID: 20090948 PMCID: PMC2806913 DOI: 10.1371/journal.pone.0008736] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 12/21/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prostatitis and sexually transmitted diseases (STDs) have been positively associated with prostate cancer in previous case-control studies. However, results from recent prospective studies have been inconclusive. METHODOGY/PRINCIPAL FINDINGS: We investigated the association between prostatitis, STDs, and prostate cancer among African American, Asian American, Latino, and White participants of the California Men's Health Study. Our analysis included 68,675 men, who completed a detailed baseline questionnaire in 2002-2003. We identified 1,658 incident prostate cancer cases during the follow-up period to June 30, 2006. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals. Overall, men having a history of prostatitis had an increased risk of prostate cancer than men with no history (RR = 1.30; 95% CI: 1.10-1.54). Longer duration of prostatitis symptoms was also associated with an increased risk of prostate cancer (P trend = 0.003). In addition, among men screened for prostate cancer (1 or 2 PSA tests), a non-significant positive association was observed between prostatitis and prostate cancer (RR = 1.10; 95% CI: 0.75-1.63). STDs were not associated with overall prostate cancer risk. In racial/ethnic stratified analysis, Latinos reporting any STDs had an increased risk of disease than those with no STDs (RR = 1.43; 95% CI: 1.07-1.91). Interestingly, foreign-born Latinos displayed a larger risk associated with STDs (RR = 1.87; 95% CI: 1.16-3.02) than U.S. born Latinos (RR = 1.15; 95% CI: 0.76-3.02). CONCLUSION In summary, results from this prospective study suggest that prostatitis and STDs may be involved in prostate cancer susceptibility. While we cannot rule out the possible influence of incidental detection, future studies are warranted to further investigate the role of infectious agents related to prostatitis and STDs in prostate cancer development.
Collapse
|
43
|
Sandhu JS. Management of elevated prostate-specific antigen in men with nonbacterial chronic prostatitis. Curr Urol Rep 2009; 10:302-6. [PMID: 19570492 DOI: 10.1007/s11934-009-0049-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Elevated serum prostate-specific antigen (PSA) in the setting of acute or chronic bacterial prostatitis is common. Serum PSA, however, is much more variable in the setting of chronic nonbacterial prostatitis. Because elevated serum PSA is associated with prostate cancer and is used in screening programs for prostate cancer, patients with benign causes for elevation of serum PSA present a challenge. This article reviews the management of patients with elevated serum PSA and a diagnosis of chronic nonbacterial prostatitis.
Collapse
|
44
|
The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome. Inflamm Res 2009; 58:829-36. [DOI: 10.1007/s00011-009-0086-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/17/2009] [Accepted: 08/19/2009] [Indexed: 11/25/2022] Open
|
45
|
Hou Y, DeVoss J, Dao V, Kwek S, Simko JP, McNeel DG, Anderson MS, Fong L. An aberrant prostate antigen-specific immune response causes prostatitis in mice and is associated with chronic prostatitis in humans. J Clin Invest 2009; 119:2031-41. [PMID: 19603556 PMCID: PMC2701875 DOI: 10.1172/jci38332] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 04/08/2009] [Indexed: 12/19/2022] Open
Abstract
Chronic prostatitis is a common disease of unclear etiology and has no specific treatment. Mice deficient in the expression of the autoimmune regulator (Aire) gene, which are defective in thymic expression of self antigens and central tolerance, develop spontaneous prostatitis. In this study, we found that Aire-deficient mice developed spontaneous B and T cell immune responses to a prostate autoantigen, seminal vesicle secretory protein 2 (SVS2), which we believe to be novel. We show that thymic expression of this self antigen was Aire dependent. Moreover, prostatitis was induced in WT mice through immunization with SVS2, demonstrating that immunity to SVS2 was sufficient to induce prostatitis. The clinical relevance of this antigen was highlighted by our observation that patients with chronic prostatitis possessed specific autoantibodies against the human SVS2-like seminal vesicle protein semenogelin. These results provide direct evidence that spontaneous chronic prostatitis is an autoimmune disease and is regulated by both central and peripheral tolerance. Moreover, SVS2 and semenogelin are among the relevant autoantigens in mice and humans, respectively.
Collapse
Affiliation(s)
- Yafei Hou
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Jason DeVoss
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Vinh Dao
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Serena Kwek
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Jeffrey P. Simko
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Douglas G. McNeel
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Mark S. Anderson
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| | - Lawrence Fong
- Division of Hematology/Oncology, Department of Medicine,
Diabetes Center, and
Department of Pathology, UCSF, San Francisco, California, USA.
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA
| |
Collapse
|
46
|
Abstract
Prostate cancer and chronic prostatitis are prevalent disorders in men. The cause of prostate cancer and chronic prostatitis is multifocal and diverse. Both disorders exhibit characteristic elevation of serum prostate-specific antigen, currently the primary screening test for prostate cancer. Prostate inflammation, regardless of cause, is the histopathologic hallmark of chronic prostatitis. In general, inflammation is associated with multiple cancers, and prostate inflammation, in particular, is a suggested factor in the development and progression of prostate cancer. This review addresses the link between chronic prostatitis and prostate cancer, especially as it relates to clinical practice.
Collapse
|
47
|
Bharucha AE, Trabuco E. Functional and chronic anorectal and pelvic pain disorders. Gastroenterol Clin North Am 2008; 37:685-96, ix. [PMID: 18794003 PMCID: PMC2676775 DOI: 10.1016/j.gtc.2008.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Several organic and functional disorders of the urinary bladder, reproductive tract, anorectum, and the pelvic floor musculature cause pelvic pain. This article describes functional disorders in which chronic pelvic and anorectal pain cannot be explained by a structural or other specified pathology. Currently, these functional disorders are classified into urogynecologic conditions or cystitis and painful bladder syndrome, anorectal disorders, and the levator ani syndrome. Although nomenclature suggests that these conditions are distinct, there is considerable overlap of their symptoms and these disorders have much in common.
Collapse
Affiliation(s)
- Adil E. Bharucha
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Emanuel Trabuco
- Department of Obstetrics and Gynecology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
48
|
Chuang YC, Yoshimura N, Huang CC, Wu M, Chiang PH, Chancellor MB. Intraprostatic botulinum toxin a injection inhibits cyclooxygenase-2 expression and suppresses prostatic pain on capsaicin induced prostatitis model in rat. J Urol 2008; 180:742-8. [PMID: 18554636 DOI: 10.1016/j.juro.2007.07.120] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Cyclooxygenase-2 is a key enzyme in the conversion of arachidonic acid to prostaglandins, which are important mediators of inflammation and pain. We investigated the effect of intraprostatic botulinum toxin A administration on pain reaction and cyclooxygenase-2 expression in a capsaicin induced prostatitis model in rats. MATERIALS AND METHODS Adult male Sprague-Dawley rats were injected with vehicle or capsaicin (10 mM, 0.1 cc) into the prostate. The nociceptive effects of capsaicin were evaluated for 30 minutes using a behavior approach. The prostate and L6 spinal cord were then removed for histology and cyclooxygenase-2 expression using Western blotting or immunostaining. A second set of animals was injected with botulinum toxin A (5 to 20 U) into the prostate 1 week before intraprostatic injection of capsaicin. RESULTS Capsaicin induced increased pain behavior and inflammatory reaction. Botulinum toxin A 1 week before treatment dose dependently decreased inflammatory cell accumulation, cyclooxygenase-2 expression and prostatic pain. Botulinum toxin A (20 U) significantly decreased inflammatory cell accumulation, and cyclooxygenase-2 expression in the prostate, ventral horn and dorsal horn of the L6 spinal cord (93.5%, 89.4%, 90.5% and 77.5%, respectively). It decreased pain behavior for eye and locomotion scores (59.5% and 40.0%, respectively). CONCLUSIONS Intraprostatic capsaicin injection activates cyclooxygenase-2 expression in the prostate, and spinal sensory and motor neurons, and it induces prostatic pain. Botulinum toxin A pretreatment could inhibit capsaicin induced cyclooxygenase-2 expression from the peripheral organ to the L6 spinal cord and inhibit prostatic pain and inflammation. This finding suggests a potential clinical benefit of botulinum toxin A for the treatment of nonbacterial prostatitis.
Collapse
Affiliation(s)
- Yao-Chi Chuang
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
PURPOSE We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.
Collapse
Affiliation(s)
- Michel A Pontari
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
| | | |
Collapse
|
50
|
Zegarra Montes LR, Sanchez Mejia AA, Loza Munarriz CA, Gutierrez EC. Semen and urine culture in the diagnosis of chronic bacterial prostatitis. Int Braz J Urol 2008; 34:30-7, discussion 38-40. [DOI: 10.1590/s1677-55382008000100006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2007] [Indexed: 11/22/2022] Open
|