Tammela T L, Wein A J, Levin R M
Division of Urology, University of Pennsylvania School of Medicine, Philadelphia.
J Urol. 1992 Dec;148(6):1937-40. doi: 10.1016/s0022-5347(17)37088-x.
The response of the rabbit urinary bladder to field stimulation (80 volts, 2-32 Hz, 1 msec duration) is biphasic, consisting of an initial phasic contraction mediated by cholinergic and purinergic neurotransmitters, followed by a prolonged tonic contraction which is solely cholinergic. Obstructive hypertrophy of the bladder induces a variety of contractile alterations including a significantly greater reduction in the tonic component of the contractile response as compared to the phasic component. This results in a severe dysfunction in the ability of the bladder to empty. One possibility is that the inability of the bladder to maintain tension and empty efficiently may be related to a degeneration of nerves innervating the bladder smooth muscle. In addition to the well documented neuropathy, the bladder undergoes hypertrophy +/- hyperplasia of both smooth muscle and interstitial cellular elements, alterations in the metabolism of substrates, alterations in the synthesis of structural and smooth muscle proteins, and alterations in the deposition of collagen. The purpose of this study was to 1) to create a specific neuropathy in the absence of the additional structural, smooth muscle, and metabolic changes that are induced by partial outlet obstruction; and 2) determine if the contractile dysfunctions induced by the neuropathy have properties similar to the contractile dysfunctions induced by outlet obstruction. In the present study, a progressive "smooth muscle neuropathy" was induced in isolated strips of male rabbit urinary bladder smooth muscle by incubating isolated strips of urinary bladder body in the presence of increasing concentrations of tetrodotoxin (15-1500 nM). In these studies, we determined the effect of increasing concentrations of tetrodotoxin (TTX) on the response to field stimulation utilizing 2 Hz and 32 Hz, at 80 V and 1 ms duration. The effects of TTX on maximum rate of contraction, peak contraction and tonic contraction were monitored. In addition, the effects of atropine (cholinergic muscarinic blockage) and ATP-desensitization (purinergic inhibition) on the effects of TTX were also determined. The results can be summarized as follows: 1) Both atropine and ATP desensitization individually inhibited significantly the peak response to field stimulation. 2) Atropine abolished the tonic response. 3) TTX inhibited the tonic contraction at significantly lower concentrations than it inhibited peak contraction. Thus, at low concentrations of TTX, a condition similar to that seen in obstructive hypertrophy was created. 4) The ED50 in the presence of atropine was significantly greater than the ED50 following ATP desensitization. This may indicate that there are separate synaptic elements for cholinergic and purinergic transmission.(ABSTRACT TRUNCATED AT 400 WORDS)
兔膀胱对场刺激(80伏,2 - 32赫兹,持续时间1毫秒)的反应是双相的,包括由胆碱能和嘌呤能神经递质介导的初始相性收缩,随后是仅由胆碱能介导的长时间紧张性收缩。膀胱梗阻性肥大诱导多种收缩改变,包括与相性成分相比,紧张性成分的收缩反应显著更大程度降低。这导致膀胱排空能力严重受损。一种可能性是,膀胱无法维持张力并有效排空可能与支配膀胱平滑肌的神经退变有关。除了有充分记录的神经病变外,膀胱还经历平滑肌和间质细胞成分的肥大和/或增生、底物代谢改变、结构和平滑肌蛋白合成改变以及胶原蛋白沉积改变。本研究的目的是:1)在不存在部分出口梗阻诱导的额外结构、平滑肌和代谢变化的情况下,产生一种特定的神经病变;2)确定由神经病变诱导的收缩功能障碍是否具有与出口梗阻诱导的收缩功能障碍相似的特性。在本研究中,通过在存在递增浓度的河豚毒素(15 - 1500纳摩尔)的情况下孵育雄性兔膀胱体的离体条带,在离体的兔膀胱平滑肌条带中诱导出进行性“平滑肌神经病变”。在这些研究中,我们利用80伏、1毫秒持续时间、2赫兹和32赫兹的场刺激,确定递增浓度的河豚毒素(TTX)对反应的影响。监测TTX对最大收缩速率、峰值收缩和紧张性收缩的影响。此外,还确定了阿托品(胆碱能毒蕈碱阻断)和ATP脱敏(嘌呤能抑制)对TTX作用的影响。结果可总结如下:1)阿托品和ATP脱敏单独均显著抑制对场刺激的峰值反应。2)阿托品消除了紧张性反应。3)TTX抑制紧张性收缩的浓度显著低于其抑制峰值收缩的浓度。因此,在低浓度的TTX下,产生了一种与梗阻性肥大中所见情况相似的状态。4)存在阿托品时的半数有效剂量(ED50)显著大于ATP脱敏后的ED50。这可能表明胆碱能和嘌呤能传递存在独立的突触元件。(摘要截断于400字)