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Werneburg GT, Keslar KS, Gotwald P, Doolittle J, Vij SC, Lee BH, Shoskes DA. Neuroinflammatory gene expression analysis reveals potential novel mediators and treatment targets in interstitial cystitis with Hunner lesions. Transl Androl Urol 2022; 10:4100-4109. [PMID: 34984176 PMCID: PMC8661250 DOI: 10.21037/tau-21-657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background We sought to study differential neuroinflammatory gene expression in men with interstitial cystitis (IC) with Hunner lesions compared with asymptomatic controls using NanoString, which uses barcoded probes to measure hundreds of genes. IC is a heterogenous condition lacking reliable biomarkers, and a subset of patients exhibits Hunner lesions, implicating the bladder as an inflammatory pain generator. Methods Blood, urine, and bladder biopsies were collected from 6 men with IC and Hunner lesions. 7 asymptomatic controls had blood and urine collected and 2 benign bladder biopsies were obtained from our tissue bank. RNA was isolated and analyzed with NanoString Human Neuroinflammation panel. Gene expression was considered significant if there was a >1.5-fold change and adjusted P value <0.05 compared with controls. Results Mean patient age was 61.5 years with 8 years median symptom duration. In bladder tissue, while many cytokine and chemokine genes had higher expression as expected (e.g., TNF, CXCL10), other significant genes included TRPA1 (1098-fold increased, expressed in pain sensing neurons) and TNFRSF17 (735-fold, B-cell related). In urine, there was 114-fold increase in S1PR4, which mediates pain via TRP-dependent pathways. A patient on cyclosporine had lower inflammatory gene expression levels relative to other IC patients, but no difference in TRPA1. Conclusions Men with IC and Hunner lesions have a diverse set of neuroinflammatory genes with differential expression compared to controls. We identified genes linked to neuropathic pain through the TRP pathway and this expression was not reduced by cyclosporine. These findings open a new direction for biomarker and therapeutic discovery.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Karen S Keslar
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paige Gotwald
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Johnathan Doolittle
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Byron H Lee
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel A Shoskes
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
Background To explore the real-life practice of clinical management of interstitial cystitis (IC) in Japan. Methods A questionnaire on the number of IC patients, cystoscopic findings, diagnostic methods, and the treatment modalities was sent via e-mail to 114 medical institutions belonging to the Society of Interstitial Cystitis of Japan (SICJ). Results Completed questionnaires were returned from 62 institutions (20 university hospitals, 26 general hospitals and 16 clinics), with a response rate of 54%. The median of patient number per institution was 20 and the national number of IC patients was counted as 4,531 in Japan. The number of new patients in 2013 was 7 (median) per institution and calculated as 1,214 in total. The case volume per institution distributed broadly and skewed to a lower volume. The patients were categorized according to cystoscopic findings as either Hunner type IC with Hunner lesions (n=2,066, 45%), non-Hunner type IC with glomerulations on hydrodistension (n=1,720, 38%) or hypersensitive bladder without endoscopic abnormalities (n=304, 7%), excluding unknown (n=441, 10%). The proportion of Hunner type IC was highly variable among the institutions, ranging from 0% to 100% with a median of 29%. As for evaluation, symptom and quality of life (QOL) assessment by questionnaires, frequency volume chart, urinalysis, urine cytology, urine culture, post-void residual measurement, uroflowmetry, ultrasound and cystoscopy were widely adapted. Administration of oral medicines and intravesical instillation therapy were undertaken at 98% and 63% of institutions, respectively. Hydrodistension was commonly performed, totaling in 812 procedures at 53 institutions, while only five cystectomies were reported from four institutions. Conclusions The survey estimated about 4,500 IC patients and 2,000 Hunner type IC patients in Japan. It also revealed a wide range of case volume, acceptable adherence to clinical guidelines, and high variability in the proportion of Hunner type IC. The variable proportions of Hunner type IC despite a high performing rate of endoscopy suggest inconsistency in diagnostic criteria for the Hunner lesion.
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Affiliation(s)
- Yukio Yamada
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Akira Nomiya
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Aya Niimi
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yasuhiko Igawa
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Takaaki Ito
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Hikaru Tomoe
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Mineo Takei
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Tomohiro Ueda
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yukio Homma
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
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Abstract
The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.
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Affiliation(s)
- Megan Danielle Atchley
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
| | - Nima M Shah
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
| | - Kristene E Whitmore
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
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Mullins C, Bavendam T, Kirkali Z, Kusek JW. Novel research approaches for interstitial cystitis/bladder pain syndrome: thinking beyond the bladder. Transl Androl Urol 2016; 4:524-33. [PMID: 26813921 PMCID: PMC4708560 DOI: 10.3978/j.issn.2223-4683.2015.08.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite years of basic and clinical research focused on interstitial cystitis/bladder pain syndrome (IC/BPS), including clinical trials of candidate therapies, there remains an insufficient understanding of underlying cause(s), important clinical features and a lack of effective treatments for this syndrome. Progress has been limited and is likely due to many factors, including a primary focus on the bladder and lower urinary tract as origin of symptoms without adequately considering the potential influence of other local (pelvic) or systemic factors. Traditionally, there has been a lack of sufficiently diverse expertise and application of novel, integrated methods to study this syndrome. However, some important insights have been gained. For example, epidemiological studies have revealed that IC/BPS is commonly associated with other chronic pain conditions, including fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. These observations suggest that IC/BPS may involve systemic pathophysiology, including alterations of the central nervous system in some patients. Furthermore, there may be multiple causes and contributing factors that manifest in the symptoms of IC/BPS leading to multiple patient sub-groups or phenotypes. Innovative research is necessary to allow for a more complete description of the relationship between this syndrome and other disorders with overlapping symptoms. This report provides examples of such innovative research studies and their findings which have the potential to provide fresh insights into IC/BPS and disorders associated with chronic pain through characterization of broad physiologic systems, as well as assessment of the contribution of the bladder and lower urinary tract. They may also serve as models for future investigation of symptom-based urologic and non-urologic disorders that may remain incompletely characterized by previous, more traditional research approaches. Furthermore, it is anticipated a more holistic understanding of chronic urologic pain and dysfunction will ensue from productive interactions between IC/BPS studies like those described here and broader cutting-edge research endeavors focused on potentially related chronic pain disorders. A more comprehensive vision for IC/BPS inquiry is anticipated to yield new insights into basic disease mechanisms and clinical characteristics that will inform future research studies that will lead to more effective therapies and improved clinical care for these patients.
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Affiliation(s)
- Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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