Interstitial cystitis/bladder pain syndrome: The evolving landscape, animal models and future perspectives.
Interstitial cystitis/bladder pain syndrome: The evolving landscape, animal models and future perspectives.
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DOI：
10.1111/iju.14229
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Homma Y
中科院分区：
文献类型：
--
作者：
Akiyama Y;Luo Y;Hanno PM;Maeda D;Homma Y
间质性膀胱炎/膀胱疼痛综合征是一种病因不明的衰弱性疾病，其特征是持续性盆腔疼痛伴下尿路症状，包括各种可能具有不同病因的潜在临床有用表型。目前的临床病理学和基因组学证据表明，间质性膀胱炎/膀胱疼痛综合征应根据是否存在Hunner病变进行分类，而不是根据膀胱学的临床表型进行分类。Hunner病变亚型是一种独特的炎性疾病，具有已证实的膀胱病因学，其特征在于上皮剥脱和增强的免疫应答，通常伴有浸润性B细胞的克隆扩增，具有潜在的感染参与。同时，非Hunner病变亚型是一种非炎症性疾病，几乎没有证据表明膀胱病因。它可能与尿路上皮功能障碍和神经生理功能障碍有关，并经常出现躯体和/或心理症状，通常导致中枢神经致敏。自身免疫性膀胱炎和神经原性致敏的动物模型可分别作为Hunner病变和非Hunner病变亚型的疾病模型。在这里，我们根据目前的研究重新分类间质性膀胱炎/膀胱疼痛综合征，并讨论其潜在的病理生理学和代表性的动物模型。基于膀胱镜检查对间质性膀胱炎/膀胱疼痛综合征进行分类是为每种亚型设计优化治疗和研究策略的必要条件。针对Hunner病变亚型的特征性炎症和上皮剥脱或非Hunner病变亚型的尿路上皮功能障碍、致敏/改变的神经系统和心理社会问题的定制方法对于这种复杂疾病的更好临床管理和研究进展至关重要。
Interstitial cystitis/bladder pain syndrome is a debilitating condition of unknown etiology characterized by persistent pelvic pain with lower urinary tract symptoms and comprises a wide variety of potentially clinically useful phenotypes with different possible etiologies. Current clinicopathological and genomic evidence suggests that interstitial cystitis/bladder pain syndrome should be categorized by the presence or absence of Hunner lesions, rather than by clinical phenotyping based on symptomatology. The Hunner lesion subtype is a distinct inflammatory disease with proven bladder etiology characterized by epithelial denudation and enhanced immune responses frequently accompanied by clonal expansion of infiltrating B cells, with potential engagement of infection. Meanwhile, the non-Hunner lesion subtype is a non-inflammatory disorder with little evidence of bladder etiology. It is potentially associated with urothelial malfunction and neurophysiological dysfunction, and frequently presents with somatic and/or psychological symptoms, that commonly result in central nervous sensitization. Animal models of autoimmune cystitis and neurogenic sensitization might serve as disease models for the Hunner lesion and non-Hunner lesion subtypes, respectively. Here, we revisit the taxonomy of interstitial cystitis/bladder pain syndrome according to current research, and discuss its potential pathophysiology and representative animal models. Categorization of interstitial cystitis/bladder pain syndrome based on cystoscopy is mandatory to design optimized treatment and research strategies for each subtype. A tailored approach that specifically targets the characteristic inflammation and epithelial denudation for the Hunner lesion subtype, or the urothelial malfunction, sensitized/altered nervous system and psychosocial problems for the non-Hunner lesion subtype, is essential for better clinical management and research progress in this complex condition.
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影响因子：
4.6
作者：
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通讯作者：
Homma Y
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DOI：
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发表时间：
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影响因子：
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作者：
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