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Meyer EJ, Wittert GA. Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab 2024; 109:e1267-e1279. [PMID: 37758218 PMCID: PMC10876414 DOI: 10.1210/clinem/dgad572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.
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Affiliation(s)
- Emily Jane Meyer
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gary Allen Wittert
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Shin D, Yoon BI, Kim S, Piao J, Jeon KH, Kwon Y, Park SH, Koo YT, Kim JS, Lee DS, Ha US, Kim SW, Jang H, Bae WJ. Cervi Parvum Cornu complex for men with lower urinary tract symptoms: a multicenter, randomized, double-blind, placebo-controlled trial. Prostate Int 2023; 11:222-227. [PMID: 38196553 PMCID: PMC10772165 DOI: 10.1016/j.prnil.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 01/11/2024] Open
Abstract
Background To evaluate the efficacy and safety of Cervi Parvum Cornu, Angelicae Gigantis Radix and Glycyrrhizae Radix complex (CAG) in men with moderate lower urinary tract symptoms (LUTS). Materials and methods From November 2020 to January 2022, participants with International Prostate Symptom Score (IPSS) of 12-19 in two centers were recruited and randomize into three groups: a CAG 500 mg/day group (CAG 500), a CAG 1000 mg/day group (CAG 1000), and a placebo group (PG). They were treated for 12 weeks. The primary endpoint was change of IPSS at the end of study from baseline. Secondary end points included change of prostate specific antigen (PSA), testosterone, dihydrotestosterone (DHT), maximum urinary flow rate (Q max), post-void residual volume (PVR), International Index of Erectile Function (IIEF), and drug safety. Results A total of 103 patients were able to finish the study according to the study protocol. Total IPSS and sub-scores (residual urine sensation, frequency, weak stream, hesistancy, nocturia, and quality of life) in CAG 500 and CAG 1000 were significantly improved at the 12th week compared to those of the PG. Changes of serum PSA, DHT, and testosterone levels at the 12th week from baseline did not show significant differences among the three groups. Q max and PVR changes did not show significant differences among the three groups either. Total IIEF and sub-scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction) in CAG 1000 were significantly improved at 12th week compared to those in PG. No significant adverse events were found. Conclusions CAG is well tolerated in patients with moderate LUTS. Treatment with CAG for 12 weeks has a therapeutic effect on moderate LUTS.
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Affiliation(s)
- Dongho Shin
- Department of Urology, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Byung Il Yoon
- Department of Urology, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Soomin Kim
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - JunJie Piao
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Hwa Jeon
- College of Pharmacy, Ewha Womans University, Seoul, Korea
| | - Youngjoo Kwon
- College of Pharmacy, Ewha Womans University, Seoul, Korea
| | - Sang-Hyuck Park
- Institute of Cannabis Research, Colorado State University Pueblo, Pueblo, CO, USA
| | | | - Jin-Soo Kim
- Kwang Dong Pharmaceutical Co, Ltd., Seoul, Korea
| | - Dong Sup Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
- Green Medicine Co., Ltd, Pusan, Korea
| | - Hoon Jang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
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Lavery TC, Spiegelhoff A, Wang K, Kennedy CL, Ridlon M, Keil Stietz KP. Polychlorinated biphenyl (PCB) exposure in adult female mice can influence bladder contractility. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:367-384. [PMID: 37941647 PMCID: PMC10628623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/21/2023] [Indexed: 11/10/2023]
Abstract
Lower urinary tract symptoms (LUTS) greatly reduce quality of life. While LUTS etiology is not completely understood, it is plausible that environmental contaminants could play a role. Polychlorinated biphenyls (PCBs), are a group of persistent environmental toxicants frequently documented in animal and human tissues. PCBs are capable of influencing voiding function in mouse offspring exposed developmentally, however whether PCB exposure during adulthood can also influence voiding dynamics is unknown. Therefore, the purpose of this study was to determine whether PCB exposure in adult female mice can impact voiding function. As part of a larger study to generate developmentally exposed offspring, adult female C57Bl/6J mice were dosed orally with the MARBLES PCB mixture (0.1, 1, or 6 mg/kg/day) or vehicle control beginning two weeks before mating and throughout gestation and lactation (9 weeks). Adult dosed female dams then underwent void spot assay, uroflowmetry, and anesthetized cystometry to assess voiding function. Bladder contractility was assessed in ex vivo bladder bath assays, and bladders were collected for morphology and histology assessments. While voiding behavior endpoints were minimally impacted, alterations to bladder contractility dynamics were more pronounced. Adult female mice dosed with 1 mg/kg/d PCB showed an increase in urine spots 2-3 cm2 in size, increased bladder contractility in response to electrical field stimulation, and decreased bladder wall thickness compared to vehicle control. PCBs also altered contractile response to cholinergic agonist in a dose-dependent manner. Overall, these results indicate that exposure to PCBs in adult female mice is sufficient to produce changes in bladder physiology. These results also highlight the critical role of timing of exposure in influencing voiding function.
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Affiliation(s)
- Thomas Cm Lavery
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
| | - Audrey Spiegelhoff
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
| | - Kathy Wang
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
| | - Conner L Kennedy
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
| | - Monica Ridlon
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
| | - Kimberly P Keil Stietz
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison Madison, Wisconsin 53706, USA
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Oliveira AL, Medeiros ML, Ghezzi AC, Dos Santos GA, Mello GC, Mónica FZ, Antunes E. Evidence that methylglyoxal and receptor for advanced glycation end products are implicated in bladder dysfunction of obese diabetic ob/ ob mice. Am J Physiol Renal Physiol 2023; 325:F436-F447. [PMID: 37560771 DOI: 10.1152/ajprenal.00089.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
Glycolytic overload in diabetes causes large accumulation of the highly reactive dicarbonyl compound methylglyoxal (MGO) and overproduction of advanced glycation end products (AGEs), which interact with their receptors (RAGE), leading to diabetes-associated macrovascular complications. The bladder is an organ that stays most in contact with dicarbonyl species, but little is known about the importance of the MGO-AGEs-RAGE pathway to diabetes-associated bladder dysfunction. Here, we aimed to investigate the role of the MGO-AGEs-RAGE pathway in bladder dysfunction of diabetic male and female ob/ob mice compared with wild-type (WT) lean mice. Diabetic ob/ob mice were treated with the AGE breaker alagebrium (ALT-711, 1 mg/kg) for 8 wk in drinking water. Compared with WT animals, male and female ob/ob mice showed marked hyperglycemia and insulin resistance, whereas fluid intake remained unaltered. Levels of total AGEs, MGO-derived hydroimidazolone 1, and RAGE in bladder tissues, as well as fluorescent AGEs in serum, were significantly elevated in ob/ob mice of either sex. Collagen content was also markedly elevated in the bladders of ob/ob mice. Void spot assays in filter paper in conscious mice revealed significant increases in total void volume and volume per void in ob/ob mice with no alterations of spot number. Treatment with ALT-711 significantly reduced the levels of MGO, AGEs, RAGE, and collagen content in ob/ob mice. In addition, ALT-711 treatment normalized the volume per void and increased the number of spots in ob/ob mice. Activation of AGEs-RAGE pathways by MGO in the bladder wall may contribute to the pathogenesis of diabetes-associated bladder dysfunction.NEW & NOTEWORTHY The involvement of methylglyoxal (MGO) and advanced glycation end products (AGEs) in bladder dysfunction of diabetic ob/ob mice treated with the AGE breaker ALT-711 was investigated here. Diabetic mice exhibited high levels of MGO, AGEs, receptor for AGEs (RAGE), and collagen in serum and/or bladder tissues along with increased volume per void, all of which were reduced by ALT-711. Activation of the MGO-AGEs-RAGE pathway in the bladder wall contributes to the pathogenesis of diabetes-associated bladder dysfunction.
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Affiliation(s)
- Akila L Oliveira
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Matheus L Medeiros
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Ana Carolina Ghezzi
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gabriel Alonso Dos Santos
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Glaucia Coelho Mello
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fabíola Z Mónica
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Edson Antunes
- Department of Translational Medicine, Pharmacology Area, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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MacIver B, Bien EM, de Oliveira MG, Hill WG. A Spectrum of Age- and Gender-Dependent Lower Urinary Tract Phenotypes in Three Mouse Models of Type 2 Diabetes. Metabolites 2023; 13:710. [PMID: 37367868 DOI: 10.3390/metabo13060710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Lower urinary tract symptoms are extremely common in people with diabetes and obesity, but the causes are unclear. Furthermore, it has proven difficult to reliably demonstrate bladder dysfunction in diabetic mouse models, thus limiting the ability to gain mechanistic insights. Therefore, the main objective of this experimental study was to characterize diabetic bladder dysfunction in three promising polygenic mouse models of type 2 diabetes. We performed periodic assessments of glucose tolerance and micturition (void spot assay) for eight to twelve months. Males and females and high-fat diets were tested. NONcNZO10/LtJ mice did not develop bladder dysfunction over twelve months. TALLYHO/JngJ males were severely hyperglycemic from two months of age (fasted blood glucose ~550 mg/dL), while females were moderately so. Although males exhibited polyuria, neither they nor the females exhibited bladder dysfunction over nine months. KK.Cg-Ay/J males and females were extremely glucose intolerant. Males exhibited polyuria, a significant increase in voiding frequency at four months (compensation), followed by a rapid drop in voiding frequency by six months (decompensation) which was accompanied by a dramatic increase in urine leakage, indicating loss of outlet control. At eight months, male bladders were dilated. Females also developed polyuria but compensated with larger voids. We conclude KK.Cg-Ay/J male mice recapitulate key symptoms noted in patients and are the best model of the three to study diabetic bladder dysfunction.
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Affiliation(s)
- Bryce MacIver
- Laboratory of Voiding Dysfunction, Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 99 Brookline Ave., Boston, MA 02215, USA
| | - Erica M Bien
- Laboratory of Voiding Dysfunction, Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 99 Brookline Ave., Boston, MA 02215, USA
| | - Mariana G de Oliveira
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, SP, Brazil
| | - Warren G Hill
- Laboratory of Voiding Dysfunction, Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 99 Brookline Ave., Boston, MA 02215, USA
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Urinary ATP Levels Are Controlled by Nucleotidases Released from the Urothelium in a Regulated Manner. Metabolites 2022; 13:metabo13010030. [PMID: 36676954 PMCID: PMC9862892 DOI: 10.3390/metabo13010030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Adenosine 5′-triphosphate (ATP) is released in the bladder lumen during filling. Urothelial ATP is presumed to regulate bladder excitability. Urinary ATP is suggested as a urinary biomarker of bladder dysfunctions since ATP is increased in the urine of patients with overactive bladder, interstitial cystitis or bladder pain syndrome. Altered urinary ATP might also be associated with voiding dysfunctions linked to disease states associated with metabolic syndrome. Extracellular ATP levels are determined by ATP release and ATP hydrolysis by membrane-bound and soluble nucleotidases (s-NTDs). It is currently unknown whether s-NTDs regulate urinary ATP. Using etheno-ATP substrate and HPLC-FLD detection techniques, we found that s-NTDs are released in the lumen of ex vivo mouse detrusor-free bladders. Capillary immunoelectrophoresis by ProteinSimple Wes determined that intraluminal solutions (ILS) collected at the end of filling contain ENTPD3 > ENPP1 > ENPP3 ≥ ENTPD2 = NT5E = ALPL/TNAP. Activation of adenylyl cyclase with forskolin increased luminal s-NTDs release whereas the AC inhibitor SQ22536 had no effect. In contrast, forskolin reduced and SQ22536 increased s-NTDs release in the lamina propria. Adenosine enhanced s-NTDs release and accelerated ATP hydrolysis in ILS and lamina propria. Therefore, there is a regulated release of s-NTDs in the bladder lumen during filling. Aberrant release or functions of urothelial s-NTDs might cause elevated urinary ATP in conditions with abnormal bladder excitability.
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Ruetten HM, Henry GH, Liu TT, Spratt HM, Ricke WA, Strand DW, Vezina CM. A NEW approach for characterizing mouse urinary pathophysiologies. Physiol Rep 2021; 9:e14964. [PMID: 34337899 PMCID: PMC8326900 DOI: 10.14814/phy2.14964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
The void spot assay (VSA) is a cost-effective method for evaluating and quantifying mouse urinary voiding phenotypes. The VSA has been used to differentiate voiding behaviors between experimental groups, but not as a diagnostic assay. To build toward this goal, we used the VSA to define voiding patterns of male mice with diabetic diuresis (BTBR.Cg-Lepob /WiscJ mice), irritative urinary dysfunction (E. coli UTI89 urinary tract infection), and obstructive urinary dysfunction (testosterone and estradiol slow-release implants) compared to their respective controls. Many studies compare individual VSA endpoints (urine spot size, quantity, or distribution) between experimental groups. Here, we consider all endpoints collectively to establish VSA phenomes of mice with three different etiologies of voiding dysfunction. We created an approach called normalized endpoint work through (NEW) to normalize VSA outputs to control mice, and then applied principal components analysis and hierarchical clustering to 12 equally weighted, normalized, scaled, and zero-centered VSA outcomes collected from each mouse (the VSA phenome). This approach accurately classifies mice based on voiding dysfunction etiology. We used principal components analysis and hierarchical clustering to show that some aged mice (>24 m old) develop an obstructive or a diabetic diuresis VSA phenotype while others develop a unique phenotype that does not cluster with that of diabetic, infected, or obstructed mice. These findings support use of the VSA to identify specific urinary phenotypes in mice and the continued use of aged mice as they develop urinary dysfunction representative of the various etiologies of LUTS in men.
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Affiliation(s)
- Hannah M. Ruetten
- Department of Comparative BiosciencesUniversity of Wisconsin‐MadisonMadisonWIUSA
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
| | - Gervaise H. Henry
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUT Southwestern Medical CenterDallasTXUSA
| | - Teresa T. Liu
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Heidi M. Spratt
- Department of Preventive Medicine and Population HealthUniversity of Texas Medical BranchGalvestonTXUSA
| | - William A. Ricke
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Douglas W. Strand
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUT Southwestern Medical CenterDallasTXUSA
| | - Chad M. Vezina
- Department of Comparative BiosciencesUniversity of Wisconsin‐MadisonMadisonWIUSA
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
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