CTGF drives voiding dysfunction through expression of collagen in periurethral SRD5A2+ fibroblasts

项目摘要--项目2 下尿路症状每年花费超过40亿美元。尽管目前的医学疗法减少了 前列腺体积和松弛平滑肌可以解决症状，现有的治疗方法都不能治愈。三件事 明确的是：(1)男性下尿路症状源于多种潜在的病理，而不仅仅是前列腺 肌肉肥大或肌肉功能障碍(2)目前的治疗方法不能有效地针对良性以外的病理 以及(3)有必要确定其他机制。 潜在的下尿路症状病因，以制定更有效的治疗方法。最重要的是 奥布莱恩良性泌尿学研究中心的目标是确定导致下尿量的机制 与前列腺相关的下尿路症状(LUTS)。前列腺胶原蛋白沉积 (纤维化)已被确定为男性下尿路症状的原因之一。前列腺胶原蛋白沉积 与前列腺僵硬、下尿路症状和药物治疗失败有关。它不会是 可能治疗前列腺纤维化和相关的排尿功能障碍，直到前列腺胶原生成细胞 已确认身份。这个项目的目标是通过精确定位细胞和分子起源来应对这一挑战 前列腺胶原蛋白的病理性产生。 人前列腺成纤维细胞的一个亚群，位于靠近尿道处并表达类固醇 5种阿尔法还原酶II(SRD5A2)已被发现，支持炎症的中心假说 使这些成纤维细胞增殖，合成结缔组织生长因子(CTGF)并产生胶原蛋白。 胶原蛋白的积聚依次导致尿路僵硬、膀胱出口梗阻、尿潴留和 排尿功能障碍。这项拟议的研究为前列腺纤维化的发病机制提供了重要的见解。 下尿路症状内科治疗失败的机制。目标1将检验假设 炎症增加人前列腺SRD5A2+成纤维细胞频率并促使CTGF和COL1A2 表情。目的2检测炎症是否增加小鼠前列腺srd5a2+成纤维细胞的频率和 这些成纤维细胞的耗尽是否能解决炎症介导的胶原堆积和排尿 功能障碍。Aim 3将测试CTGF过表达是否足以驱动小鼠前列腺胶原 蓄积和排尿功能障碍以及一种研究用的新的CTGF阻断药物是否能解决 有问题。拟议的研究将确定在SRD5A2+成纤维细胞中CTGF的表达作为治疗靶点 用于治疗下尿路症状。通过建立炎症之间的机制联系，CTGF 以及COL1A2丰度和排尿功能障碍，这些研究启动了对一种疾病的原创性研究 这一过程尚未被用作治疗下尿路症状的药物治疗的目标。

PROJECT SUMMARY- PROJECT 2 Lower urinary tract symptoms cost more than $4 billion annually. Though current medical therapies reduce prostate volume and relax smooth muscle to address symptoms, existing therapies are not curative. Three things are clear: (1) male lower urinary tract symptoms derive from multiple underlying pathologies, not just prostatic enlargement or muscle dysfunction (2) current therapies do not effectively target pathologies outside of benign enlargement and smooth muscle dysfunction, and (3) there is a need to identify additional mechanisms underlying lower urinary tract symptom etiology to formulate therapies that are more effective. The overarching goal of the O’Brien Center for Benign Urology Research is to identify mechanisms that result in lower urinary tract dysfunction and prostate-related lower urinary tract symptoms (LUTS). Prostatic collagen accumulation (fibrosis) has been identified as a cause of male lower urinary tract symptoms. Prostatic collagen accumulation has been linked to prostatic stiffness, lower urinary tract symptoms, and failed medical treatment. It will not be possible to treat prostatic fibrosis and associated voiding dysfunction until prostatic collagen-producing cells are identified. The goal of this project is to tackle this challenge by pinpointing the cellular and molecular origins of pathological collagen production in the prostate. A subpopulation of human prostatic fibroblasts residing in close proximity to the urethra and expressing steroid five alpha reductase type II (SRD5A2) has been identified, supporting the central hypothesis that inflammation causes these fibroblasts to proliferate, synthesize connective tissue growth factor (CTGF) and produce collagen. Collagen accumulation in turn leads to urethral stiffening, bladder outlet obstruction, urinary retention, and voiding dysfunction. The proposed studies offers essential insight into the pathogenesis of prostatic fibrosis, a mechanism of lower urinary tract symptom medical therapy failure. Aim 1 will test the hypothesis that inflammation increases human prostatic SRD5A2+ fibroblast frequency and drives CTGF and COL1A2 expression. Aim 2 tests whether inflammation increases frequency of mouse prostatic Srd5a2+ fibroblasts and whether depletion of these fibroblasts resolves inflammation-mediated collagen accumulation and voiding dysfunction. Aim 3 will test whether CTGF overexpression is sufficient to drive mouse prostatic collagen accumulation and voiding dysfunction and whether an investigational new CTGF blocking drug resolves the problems. The proposed studies will pinpoint CTGF expression in SRD5A2+ fibroblasts as a therapeutic target for treating lower urinary tract symptoms. By establishing mechanistic connections between inflammation, CTGF and COL1A2 abundance, and urinary dysfunction, the studies launch an original line of research into a disease process that is yet-to-be leveraged as a target for medical therapies addressing lower urinary tract symptoms.