Low energy shock wave‐delivered intravesical botulinum neurotoxin‐A potentiates antioxidant genes and inhibits proinflammatory cytokines in rat model of overactive bladder

Nageib, Mohammed; Zahran, Mohamed H; El‐Hefnawy, Ahmed S.; Barakat, Nashwa; Awadalla, Amira; Aamer, Haytham G.; Khater, Sherry M.; Shokeir, Ahmed A.

doi:10.1002/nau.24511

Cited by 12 publications

(5 citation statements)

References 25 publications

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“…Another OAB rat study using an intravesical instillation of BoNT-A plus LESW treatment showed a statistically significantly lower amplitude and lower frequency of detrusor contractions in the rats receiving treatment. LESW plus BoNT-A was also associated with statistically significantly lower expressions of TNF-α and IL-6 and significantly reduced submucosal edema and inflammatory cell infiltration [ 97 ]. LESW has been shown to be effective in increasing urothelial permeability to BoNT-A and in enhancing the therapeutic effect on the OAB rat model, possibly through anti-inflammatory and antioxidative stress effects.…”

Section: Lesw Enhances Penetration Of Bont-a Across the Urothelium In...mentioning

confidence: 99%

“…One recent clinical trial in OAB patients also showed that LESW is a safe and effective method for treating refractory OAB with a response duration of 2 months [ 84 ], while intravesical instillation of BoNT-A plus LESW showed statistically significantly lower amplitude and lower frequency of detrusor contractions in the OAB rats [ 97 ].To explore the potential clinical efficacy of this treatment module in patients with IC/BPS, we previously performed a pilot clinical study of a case series using suprapubic LESW to promote intravesical BoNT-A delivery. At baseline, six women with refractory IC/BPS underwent cystoscopic hydrodistention and bladder biopsy for diagnosis confirmation.…”

Section: Lesw Enhances Penetration Of Bont-a Across the Urothelium In...mentioning

confidence: 99%

“…In the pilot study of LESW plus BoNT-A on IC/BPS, we only reported a preliminary result together with possible pathophysiology and a previous animal study. In the human LESW trial, the therapeutic effect of LESW monotherapy on OAB was promising [ 84 ], but the effect on inflammation of IC/BPS was limited [ 95 ], whereas LESW application plus BoNT-A instillation had been demonstrated as effective in treating IC and OAB in rats [ 96 , 97 ]. This evidence suggested that LESW with intravesical BoNT-A instillation might have a synergistic effect on IC/BPS.…”

Section: Future Research On the Application Of Lesw On Different Ic/b...mentioning

confidence: 99%

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Low-Energy Shock Wave Plus Intravesical Instillation of Botulinum Toxin A for Interstitial Cystitis/Bladder Pain Syndrome: Pathophysiology and Preliminary Result of a Novel Minimally Invasive Treatment

2022

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Low-energy shock wave (LESW) therapy is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. LESW treatment has been demonstrated to be effective in treating chronic prostatitis and pelvic pain syndrome as well as overactive bladder, and it has a potential effect on interstitial cystitis/bladder pain syndrome (IC/BPS) in humans. LESW reduces pain behavior, downregulates nerve growth factor expression, and suppresses bladder overactivity by decreasing the expression of inflammatory proteins. Previous rat IC models have shown that LESW can increase urothelial permeability, facilitate intravesical delivery of botulinum toxin A (BoNT-A), and block acetic acid-induced hyperactive bladder, suggesting that LESW might be a potential therapeutic module for relieving bladder inflammatory conditions, such as bladder oversensitivity, IC/BPS, and overactive bladder. A recent clinical trial showed that LESW monotherapy was associated with a significant reduction in pain scores and IC symptoms. BoNT-A detrusor injection or liposome-encapsulated BoNT-A instillation could also inhibit inflammation and improve IC symptoms. However, BoNT-A injection requires anesthesia and certain complications might occur. Our preliminary study using LESW plus intravesical BoNT-A instillation every week demonstrated an improvement in global response assessment without any adverse events. Moreover, an immunohistochemistry study revealed the presence of cleaved SNAP25 protein in the suburothelium of IC bladder tissue, indicating that BoNT-A could penetrate across the urothelial barrier after application of LESW. These results provide evidence for the efficacy and safety of this novel IC/BPS treatment by LESW plus BoNT-A instillation, without anesthesia, and no bladder injection. This article reviews the current evidence on LESW and LESW plus intravesical therapeutic agents on bladder disorders and the pathophysiology and pharmacological mechanism of this novel, minimally invasive treatment model for IC/BPS.

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Section: Lesw Enhances Penetration Of Bont-a Across the Urothelium In...mentioning

confidence: 99%

Section: Lesw Enhances Penetration Of Bont-a Across the Urothelium In...mentioning

confidence: 99%

Section: Future Research On the Application Of Lesw On Different Ic/b...mentioning

confidence: 99%

See 1 more Smart Citation

Low-Energy Shock Wave Plus Intravesical Instillation of Botulinum Toxin A for Interstitial Cystitis/Bladder Pain Syndrome: Pathophysiology and Preliminary Result of a Novel Minimally Invasive Treatment

2022

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“…The combination of ECSW and BTX-A has also produced advantageous results in overactive bladder and IC/BPS animal models. Transient urothelial permeability, following ECSWT, enables more efficient penetration of BTX-A from urine into the submucosa, without the need for an additional injection of the drug into the bladder wall [ 110 , 111 ]. ECSWT has already provided encouraging results in several randomized clinical trials for the treatment of chronic prostatitis-related pain in men [ 112 , 113 ] and also holds promise for translation to clinical use in IC/BPS patients [ 114 ].…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Therapeutic Approaches Used in Experimental Models of Interstitial Cystitis/Bladder Pain Syndrome

et al. 2021

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Interstitial cystitis/bladder pain syndrome (IC/BPS) is a multifactorial, chronic bladder disorder with limited therapeutic options currently available. The present review provides an extensive overview of therapeutic approaches used in in vitro, ex vivo, and in vivo experimental models of IC/BPS. Publications were identified by electronic search of three online databases. Data were extracted for study design, type of treatment, main findings, and outcome, as well as for methodological quality and the reporting of measures to avoid bias. A total of 100 full-text articles were included. The majority of identified articles evaluated therapeutic agents currently recommended to treat IC/BPS by the American Urological Association guidelines (21%) and therapeutic agents currently approved to treat other diseases (11%). More recently published articles assessed therapeutic approaches using stem cells (11%) and plant-derived agents (10%), while novel potential drug targets identified were proteinase-activated (6%) and purinergic (4%) receptors, transient receptor potential channels (3%), microRNAs (2%), and activation of the cannabinoid system (7%). Our results show that the reported methodological quality of animal studies could be substantially improved, and measures to avoid bias should be more consistently reported in order to increase the value of preclinical research in IC/BPS for potential translation to a clinical setting.

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“…Histologically, combined treatments significantly reduced submucosal edema and inflammatory cell infiltrate scores. Moreover, BoNT-A plus LESW significantly increased tissue expression of antioxidant marker (superoxide dismutase) and suppressed oxidative stress marker (malondialdehyde) and inflammatory cytokines (tumor necrotic factor-α and interleukin-6) [59].…”

Section: Future Perspectivesmentioning

confidence: 92%

Botulinum Neurotoxin Uses in Overactive Bladder

Zahran¹,

Raheem²,

Alowidah³

et al. 2022

Botulinum Toxin - Recent Topics and Applications

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Botulinum neurotoxin has been approved for use in different urologic disorders, especially overactive bladder (OAB). OAB is highly prevalent, with a relevant impact on patients’ quality of life and the available health resources. The prevalence of OAB is 11.8% with no significant difference between male and female. Botulinum neurotoxin is now approved as a treatment of choice for refractory overactive bladder (ROAB) after the failure of behavioral and pharmacological therapy. It is associated with improvement of urgency and urge urinary incontinence in 60–70% of patients. Yet the effect is not long-standing and fades out in a mean of 6-months duration and repeated injection is warranted. Moreover, its associated side effects are not uncommon, especially urinary tract infection and urine retention. New modifications have been studied to make it less invasive, effective, and tolerable by the patients through injection-free mode. The subject to be explained in the book chapter is the role of botulinum neurotoxin in ROAB, including the mechanism of action, different types of botulinum toxin used, the accepted dose, associated side effects, and comparison of the outcome to other available treatment modalities. In addition, a close look at the new accepted approaches for intravesical administration of botulinum toxin in the bladder will be done.

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Low energy shock wave‐delivered intravesical botulinum neurotoxin‐A potentiates antioxidant genes and inhibits proinflammatory cytokines in rat model of overactive bladder

Cited by 12 publications

References 25 publications

Low-Energy Shock Wave Plus Intravesical Instillation of Botulinum Toxin A for Interstitial Cystitis/Bladder Pain Syndrome: Pathophysiology and Preliminary Result of a Novel Minimally Invasive Treatment

Low-Energy Shock Wave Plus Intravesical Instillation of Botulinum Toxin A for Interstitial Cystitis/Bladder Pain Syndrome: Pathophysiology and Preliminary Result of a Novel Minimally Invasive Treatment

A Systematic Review of Therapeutic Approaches Used in Experimental Models of Interstitial Cystitis/Bladder Pain Syndrome

Botulinum Neurotoxin Uses in Overactive Bladder

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