Is It Possible to Regenerate the Underactive Detrusor? Part 1 Molecular and Stem Cell Therapies Targeting the Urinary Bladder and Neural Axis ICI-RS 2024.

Autor: Sinha S; Department of Urology, Apollo Hospital, Hyderabad, India., Cruz F; Departamento de Urologia, Hospital de S. João, Faculdade de Medicina do Porto, Porto, Portugal., Cuenca EM; Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain., Przydacz M; Department of Urology, Jagiellonian University, Krakow, Poland., Kheir GB; Department of Urology, Ghent University, Ghent, Belgium., Kanai AJ; Department of Medicine and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Van Huele A; Department of Urology, Ghent University Hospital, Ghent, Belgium., Gajewski JB; Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada., Tarcan T; Departments of Urology, Marmara University School of Medicine and Koç University School of Medicine, Istanbul, Turkey., Lazar JM; Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA., Weiss JP; Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA., Tyagi P; Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Abrams P; Department of Urology, University of Bristol, Bristol, UK., Wein A; Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA.
Jazyk: angličtina
Zdroj: Neurourology and urodynamics [Neurourol Urodyn] 2024 Oct 07. Date of Electronic Publication: 2024 Oct 07.
DOI: 10.1002/nau.25597
Abstrakt: Introduction: Detrusor muscle weakness is commonly noted on urodynamics in patients with refractory voiding difficulty. No approved therapies have been proven to augment the strength of a detrusor voiding contraction.
Methods: This subject was discussed by a think-tank at the International Consultation on Incontinence- Research Society (ICI-RS) meeting held in Bristol, June 2024. The discussions of the think-tank are being published in two parts. This first part discusses molecular and stem cell therapies targeting the urinary bladder and the neural axis.
Results: Senescence of the urothelium and extracellular ATP acting through P2X3 receptors might be important in detrusor underactivity. Several molecules such as parasympathomimetics, acotiamide, ASP8302, neurokinin-2 agonists have been explored but none has shown unequivocal clinical benefit. Different stem cell therapy approaches have been used, chiefly in neurogenic dysfunction, with some studies showing benefit. Molecular targets for the neural axis have included TRPV-4, Bombesin, and serotoninergic receptors and TAC-302 which induces neurite growth.
Conclusions: Several options are currently being pursued in the search for an elusive molecular or stem cell option for enhancing the power of the detrusor muscle. These encompass a wide range of approaches that target each aspect of the contraction mechanism including the urothelium of bladder and urethra, myocyte, and neural pathways. While none of these have shown unequivocal clinical utility, some appear promising. Lessons from other fields of medicine might prove instructive.
Clinical Trial Registration: Not necessary. Not a clinical trial.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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