Enhanced Adenosine Triphosphate Release From The Urothelium Of Patients With Painful Bladder Syndrome: A Possible Pathophysiological Explanation

Main Category: Urology / Nephrology
Also Included In: Neurology / Neuroscience;  Pain / Anesthetics;  Biology / Biochemistry
Article Date: 13 Jan 2008 - 0:00 PDT

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UroToday.com- Adenosine triphosphate (ATP) has been increasingly recognized as an important sensory neurotransmitter. A number of studies support the idea that mechanical stimuli can evoke ATP release from epithelial cells lining tubes or sacs, such as the bladder. Release of ATP may activate P2X receptors on suburothelial sensory nerves and thus may have an important role in sensory functions, such as nociception.

Researchers in the United Kingdom and Australia biopsied urothelium from patients with painful bladder syndrome and stretched the tissue by 130% and 150%, and subjected it to electrical stimulation. When compared with controls there was a significantly greater release of ATP following mechanical stretch of the urothelium from BPS/IC than from control tissue. Vivek Kumar and colleagues from Sheffiel and Queensland found the source of ATP release was nonneuronal in 89% of BPS/IC bladders and 84% in the control bladders.

This study provides direct evidence for increased purinergic activity in painful disorders of the bladder. While in a normal bladder afferent activity is mediated via Aδ fibers, in pathological conditions such as BPS/IC it may occur via normally inactive C fibers. In theory increased afferent activity could be of great importance in the development of BPS/IC, the authors note, as the hallmark of the disease is hypersensitivity of the bladder to stretch, with the resulting sensation perceived as pain.

This research may provide a target for the development of new therapies for different conditions that are included in the broad category of bladder pain syndrome.

Kumar V, Chapple CR, Surprenant AM, Chess-Williams R

J of Urol. 178(4):1533-1536, October 2007
doi:10.1016/j.juro.2007.05.116

Reported by UroToday.com Contributing Editor Philip Hanno, M.D

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