Speed, sex, gay men, and HIV: ecological and community perspectives

OBJECTIVE: To find a means of bladder augmentation that would avoid the complications encountered with the use of bowel segments, using a newly developed acellular biomaterial, the bladder acellular matrix graft (BAMG), as a homologous graft. MATERIALS AND METHODS: Thirty-four rats underwent a partial cystectomy (40-50%) and grafting with a BAMG of equal size. Eleven rats died within the first 72 h. probably from urinary leakage caused by obstruction of the bladder neck with stones or coagula; the surviving 23 were killed at varying intervals after cystectomy and examined. RESULTS: After providing initial bladder enlargement, the graft was progressively infiltrated by the vessels and smooth muscle cells of the host: furthermore, the mucosal lining was complete within 10 days. After 4 weeks, all bladder wall components were evident histologically in the graft. The ingrowth was complete after 8 weeks, except for neural regeneration, which was only partial. At 12 weeks, the bladder wall muscle structure in the graft was so well developed that it was difficult to delineate the junction between host bladder and BAMG. Neural regeneration continued to improve. Normal bladder capacities were maintained throughout the study. CONCLUSION: The BAMG appears to serve, without rejection, as a framework of collagen and elastin for the ingrowth of all bladder wall components. The reason for the better acceptance of the BAMG than of other bladder augmentation grafts requires further investigation.     

In vitro functional properties of the rat bladder regenerated by the bladder acellular matrix graft

PURPOSE: To assess the response of rat urinary bladder regenerated by the homologous bladder acellular matrix graft (BAMG) to in vitro electrical and pharmacologic stimuli. MATERIALS AND METHODS: In Sprague-Dawley rats, partial cystectomy (>50%) was performed, followed by BAMG augmentation cystoplasty. After 4 months, organ bath studies of tissue strips in 10 were used to compare the contractility of the BAMG regenerates and the corresponding host detrusor smooth muscle. RESULTS: The BAMG regenerates exhibited contractile activity to electrical field stimulation and a qualitatively identical pattern of response to muscarinic, purinergic, alpha- and beta-adrenergic drug administration and nitric oxide. At 4 months after surgery, the maximum forces of contraction of the BAMG regenerates to carbachol stimulation amounted to close to 80% of the host bladder response. With electrical field stimulation, they equaled 44% and 62% of the host bladder response after 2.5 and 4 months, respectively. Histological and immunohistochemical studies confirmed the presence of receptors for neurotransmitters that these functional in vitro studies implied. CONCLUSIONS: The present study provides further evidence that augmentation cystoplasty with the BAMG leads to functional regeneration of the rat bladder detrusor smooth muscle.     

Comparison of biomechanical properties of the incisor periodontal ligament among different species

BACKGROUND: The aim of this study was to obtain a more precise understanding of the mechanical properties of the periodontal ligament in continuously erupting incisors by comparing the shear stress-strain relations among teeth from four closely related species. METHODS: Four species of experimental animals (mice, hamsters, rats, and rabbits) were used. Transverse sections of the left mandibular incisors were cut from the incisal, middle, and basal regions of each incisor. The tooth was pushed out of the alveolar bone in an extrusive direction at 5 mm/min using a materials testing machine. The maximum shear stress, maximum shear strain, tangent modulus, and failure strain energy density were estimated from the resulting stress-strain curve. Polarized light microscopic observations of collagen fibers were also made. RESULTS: All the biomechanical measures tended to decrease from the incisal toward the basal regions in all species. There were large species differences, especially in the incisal region, with the greatest maximum shear stress and failure strain energy density in hamsters. The greatest tangent modulus and the smallest maximum shear strain were observed in mice. The birefringent fiber architectures of the periodontal ligaments in the four species appeared to be similarly organized; the incisal periodontal ligament appeared to have more organized and thicker collagen fibres than did the middle and basal ligaments in the four species. CONCLUSIONS: These results suggest that the regional differences in the biomechanical properties of the periodontal ligament depend upon the developmental stages of the periodontal collagen fibers that may be related to the general arrangement, diameters, and densities of the collagen fiber bundles and the fiber insertions into the alveolar bone and cementum. The species differences in the biomechanical properties may be due to differences in the width of the periodontal ligament and the waviness as well as the strength and stiffness of the periodontal collagen fibers.     

Evaluation of smooth muscle and collagen subtypes in normal newborns and those with bladder exstrophy

PURPOSE: Many patients who undergo bladder exstrophy closure as newborns, subsequent epispadias repair and later bladder neck reconstruction become completely continent yet complications can occur. After successful initial exstrophy closure and later epispadias repair some patients may fail to gain sufficient capacity for bladder neck reconstruction or satisfactory capacity and continence after bladder neck reconstruction. In an attempt to understand the pathogenesis of these failures we compared bladder biopsies from normal neonates and those with exstrophy. MATERIALS AND METHODS: Bladder biopsies obtained from the midline of the bladder wall just above the base of the trigone from 12 newborns with exstrophy were compared to bladder sections from 9 neonatal cadavers. All bladder specimens were stained with monoclonal antibodies against type I, III or IV collagen and a subset was further stained with Masson's trichrome to define the extracellular matrix. All specimens were then analyzed using a color digital image analysis system. RESULTS: At initial examination of the extracellular matrix there was an increase in the collagen-to-smooth muscle ratio from 0.38 in controls to 1.2 in newborns with exstrophy, comprising an increase in collagen and decrease in smooth muscle. The collagen component of the extracellular matrix was then further defined to quantitate the amount of each collagen type (I, III and IV) deposited. We then evaluated the ratio of collagen type-to-total collagen sampled. Compared to control bladders there was no statistical difference in the amount of type I or IV in the bladders of newborns with exstrophy at initial closure. However, there was a 3-fold increase in type III collagen (0.14 +/- 0.05 to 0.46 +/- 0.2%, p < 0.001) in the bladders of neonatal controls versus newborns with exstrophy. CONCLUSIONS: This alteration in collagen makeup may represent an earlier developmental stage of the exstrophy bladder at birth, which then remodels and changes after successful initial closure. Further studies are underway to examine the collagen composition of bladders at bladder neck reconstruction, failed closures and augmentation.     

Failure to differentiate Cryptosporidium parvum from C. meleagridis based on PCR amplification of eight DNA sequences

PURPOSE: Little is known about the developmental effects of high urinary diversion and bladder defunctionalization in infancy. Although clinical experience shows that a poorly functional bladder may result from urinary diversion in infancy, the mechanisms of change and specific bladder wall alterations have not been well characterized. We hypothesized that cyclic filling and emptying are necessary for normal bladder development. To investigate this important question we created a new animal model. MATERIALS AND METHODS: We designed a new method of hemibladder urinary diversion in 3-week-old New Zealand white rabbits. After vertical midline bladder division half of the bladder was formed into a functional reservoir, which remained in continuity with the ipsilateral ureter and urethra. The other bladder half was defunctionalized and isolated from the urine flow by ureteral ligation. Diversion was created for 3, 7, 14 and 28 days. Urodynamic evaluation was done in the functionalized hemibladders and age matched normal rabbit bladders to test the validity of the functionalized hemibladder as an internal control. Functional and defunctionalized hemibladders as well as age matched, nonoperated normal rabbit bladders were weighed, sectioned and stained to demonstrate muscle and connective tissue components. RESULTS: In 22 of the 27 healthy rabbits (81%) good quality diverted and functional bladder specimens were obtained after diversion. Defunctionalized hemibladders grew more slowly than functionalized bladders and normal age matched control bladders. Histological staining of the bladder wall demonstrated increased connective tissue between the muscle bundles within the diverted specimens than in functional bladders. CONCLUSIONS: Our successful model of urinary diversion may be used to study the developmental and histological effects of urinary diversion in the young bladder. Bladder growth and histological appearance are altered when the stimulus of cyclic filling and emptying is removed. Further studies using this model are warranted to define fully bladder changes that result from diversion and investigate the mechanism of the observed changes.     

Renal transplantation following renal failure due to urological disorders

BACKGROUND: Renal allograft outcome, during an 8 year period (1985-1992), has been assessed in 56 renal transplants performed in 55 patients who had end-stage renal failure as a consequence of urological abnormalities. The abnormalities were: primary vesicoureteric reflux (VUR) or renal dysplasia (26 patients); posterior urethral valves (PUV) (15); neuropathic bladders (6); vesico-ureteric tuberculosis (5); bladder exstrophy (3); and prune belly syndrome (1). Six patients had augmented bladders, and eight transplants were performed in seven patients with urinary diversions. RESULTS: Overall, 1 and 5 year actuarial graft survival was 89 and 66%, with mean creatinine of 154 micromol/l +/- 11 (SE) and 145 +/- 9 respectively. Patients with abnormal bladders or conduits (n = 28) had worse graft function than those with normal bladders (n = 28) although graft survival was not significantly different in the two groups at 1 and 5 years: 93 and 75% with normal bladders vs 86 and 57% with abnormal systems. Symptomatic urinary tract infections were common in the first 3 months after transplantation (63%); fever and systemic symptoms occurred in 39% with normal bladders and 59% with abnormal bladders. Urinary tract infection directly contributed to graft loss in six patients with abnormal bladders, but had no consequences in those with normal bladders. CONCLUSIONS: Abnormal bladders must be assessed urodynamically before transplantation, and after transplantation adequacy of urinary drainage must be re-assessed frequently. Prophylactic antibiotics are now given for the first 6 months and urinary tract infections must be treated promptly. With these measures, good results, similar to those of patients without urological problems, can be obtained.     

Bladder compliance in patients with benign prostatic hyperplasia

Factors influencing bladder compliance were examined in 116 patients with benign prostatic hyperplasia (BPH), by evaluating patients' histories, response of isolated bladder strips to acetylcholine, and the effect of prostatic urethral anesthesia. Patients' age, frequency of micturition, and duration of voiding difficulty were not correlated with bladder compliance. Bladder compliance was significantly low in patients within 30 days after urinary retention, as compared with bladder compliance in patients without an episode of retention. More than 30 days after retention, however, there was a tendency toward increased bladder compliance. Restricted to patients without an episode of retention, bladder compliance in the overactive detrusor group was found to be significantly lower than in the normal group. The responses to acetylcholine of bladder strips were compared between patients with low and normal-compliance bladders. The dose-response curve of patients with low-compliance bladders did not differ from that of those with normal compliance bladders, even when patients with an episode of retention were excluded. After prostatic urethral anesthesia, a significant increase of bladder compliance was observed in patients with an overactive detrusor, while the increase was not significant in patients with a normal detrusor. Our results strongly suggest that easy irritability of the anatomically altered prostatic urethra, as well as bladder over-distension caused by urinary retention, are important factors affecting bladder compliance in BPH patients.     

Neurogenically mediated cystitis in rats: an animal model

PURPOSE: Pseudorabies virus (PRV) is a useful tool for mapping the control circuitry of the spinal cord. In the process of mapping CNS regulatory pathways for the lower urinary tract, a hemorrhagic change in the bladder was observed that was not overtly evident in other pelvic organs. The relationship between the appearance of hemorrhagic changes in the bladder and the evolution of PRV induced changes in the spinal cord was therefore explored. MATERIALS AND METHODS: Sprague-Dawley rats were injected with PRV into the ACD tail-muscle. Bladder and CNS fixation were achieved by transcardial perfusion with formaldehyde. Multi-level sections were obtained from T8 through S4. Fixed tissue was stained and evaluated by light microscopy. Immunohistochemical stains were carried out for PRV and iNOS on spinal cord tissue. We were therefore able to evaluate the relationship between the manifestation of the hemorrhagic cystitis, appearance of the PRV in the spinal cord and evidence of CNS inflammation. RESULTS: The evolution of hemorrhagic cystitis paralleled the evidence of inflammation in the thoraco-lumbar and sacral cord. These bladders contained 5 to 9 ml. of bloody urine (a normal rat bladder contains 1 to 2 ml.). On cystomanometry (CMG) the bladders were acontractile. No PRV could be cultured in the hemorrhagic bladders. The histological changes observed in the bladder represent true inflammation. CONCLUSION: There was no obvious explanation for these changes other than the associated inflammatory changes in the spinal cord. The findings are consistent with the hypothesis that a spinal cord stress, via an unknown metabolic pathway, can result in dramatic, neurogenically mediated changes in the bladder.     

A non-nitrergic smooth muscle relaxant factor released from rat urinary bladder by muscarinic receptor stimulation

PURPOSE: To study the possible release of a relaxant factor from isolated rat bladder tissue. MATERIALS AND METHODS: Thoracic aortae and urinary bladders were obtained from 55 female Sprague-Dawley rats. The bladder body was used in its original tubular shape as the donor tissue in a co-axial bioassay system, and the aorta served as acceptor tissue. RESULTS: In a co-axial bioassay system with endothelium-free, norepinephrine-contracted, rat aortic preparations mounted within urothelium-intact urinary bladder, carbachol caused a concentration-dependent relaxation, amounting to 64+/-7% (n = 10) of the induced contraction, suggesting release of a relaxing factor. The relaxant effect of carbachol was lost if the urinary bladder segment was removed. However, the relaxation was affected neither by removal of the urothelium, nor by bladder segment inversion. It was resistant to inhibition of the L-arginine/nitric oxide and cyclo-oxygenase pathways, and unaffected by beta-adrenoceptor blockade and K+ channel inhibition. The relaxation was not associated with any significant changes in the intracellular levels of cGMP or cAMP. CONCLUSION: A previously unrecognized non-adrenergic, non-nitrergic, non-prostanoid inhibitory mediator is released from the rat urinary bladder by muscarinic receptor stimulation. The physiological importance of such a factor remains to be established.     

Enhancement of rat urinary bladder tumorigenesis by lipopolysaccharide-induced inflammation

Chronic inflammation of the urinary tract is a significant risk factor for the development of urinary bladder cancer in humans. We previously demonstrated that weekly treatment with killed Escherichia coli enhanced rat urinary bladder tumorigenesis initiated by the carcinogen N-methyl-N-nitrosourea. We conducted the present study to determine whether lipopolysaccharide (LPS), a major cell wall component of E. coli, had a tumor-enhancing effect. LPS was instilled twice a week at three doses (100, 1.0, and 0.01 microgram/ml) into heterotopically transplanted rat urinary bladders which were treated with a single low dose (0.25 mg) of N-methyl-N-nitrosourea or vehicle. Rats treated with 100 micrograms/ml of LPS showed a significant increase in the incidence and number of tumors in the bladders pretreated with N-methyl-N-nitrosourea. Treatment with LPS alone did not induce tumors. The enhancing effects were associated with a marked increase in the numbers of polymorphonuclear leukocytes and an increase in the H2O2 concentration in the bladder lumen. Oxidative stress by reactive oxygen intermediates and a proliferative response of the carcinogen-exposed urothelium to the inflammatory stimulation appeared to play a significant role in tumor enhancement by LPS.     

Impact of aging on rat urinary bladder fatigue

PURPOSE: Little is known about the fatigability of the urinary bladder. In these experiments, we characterized contractile and bioenergetic changes in bladder fatigue and investigated the impact of aging on these changes. MATERIALS AND METHODS: Whole urinary bladders from 3-month-old (n = 17) and 24-month-old (n = 12) SD rats were isolated and individually mounted in organ baths. The bladders were electrostimulated repeatedly (50 volts, 32 Hz, 1 MS; every 2.5 minutes). The pressure generation, rate of pressure generation and the emptying ability (% volume emptied) of the isolated bladders were measured with each stimulation. After the 20th electrostimulation, the bladders were immediately stimulated with 500 microM bethanechol. Upon completion of their series of stimulations, some of the bladders were quickly frozen in liquid nitrogen. Tissue phosphocreatine and ATP content of the frozen bladders and a group (six 3-month-old and six 24-month-old rats) of fresh bladder tissues was determined using high performance liquid chromatography (HPLC). RESULTS: The results can be summarized as follows: (1) Pressure generation, rate of pressure generation and emptying ability were gradually reduced in both young and aged bladders as repeated stimulation proceeded. (2) The final bethanechol stimulation emptied the same intravesical volume as the 20th electrostimulation emptied (in both groups), indicating that bladder fatigue is due to a post-synaptic mechanism. (3) As compared to their own first responses, aged rats exhibited significantly greater rates of reduction in both pressure generation and emptying ability than did young rats. (4) Analysing fresh bladder tissues, the phosphocreatine and ATP concentration of the aged bladders were significantly less than those of the young bladders-13.2 +/- 2.0 and 1.2 +/- 0.3 nmol/mg. protein respectively in the aged bladders vs. 21.2 +/- 1.8 and 7.5 +/- 1.0 nmol/mg. protein respectively in the young bladders. After repeated stimulation, phosphocreatine and ATP concentration were reduced in both groups (1.4 +/- 0.3 and 0.43 +/- 0.1 nmol./mg. protein in the aged bladders, 7.5 +/- 1.4 and 4.1 +/- 0.5 nmol./mg. protein in the young bladders), with a greater degree of reduction in the aged bladders. CONCLUSION: These observations indicate that, in response to repeated electrostimulation, aged rat bladders became fatigued faster than young bladders. Decreased capability in energy production might be one contributing factor for faster fatiguability of the aged urinary bladders.     

Renal microscopic polyarteritis replaced by pericarditis with episodic increases in MPO-ANCA in a patient with systemic lupus erythematosus

BACKGROUND: An abnormally increased presence of type VI collagen has been shown in the lamina cribrosa of patients with primary and secondary glaucoma. This study was undertaken to investigate the pattern of type VI collagen within the aqueous outflow structures of glaucoma patients. METHODS: Trabecular meshwork samples of eight normal donor eyes and trabeculectomy specimens of 21 patients with different types of glaucoma were processed for either cryo-sectioning or for paraffin embedding. Immunohistochemical staining was conducted by use of polyclonal rabbit antibodies against human collagen type VI. RESULTS: Immunoreactivity for type VI collagen was evident in the cores of all trabecular beams. The strongest staining was detected in the uveal region of the human trabecular meshwork. Immunohistochemical labelling for type VI collagen was not more pronounced in the aqueous outflow structures of glaucoma patients than in normal eyes. CONCLUSION: Collagen type VI is a ubiquitous structural component of the extracellular matrix in the human trabecular meshwork. However, type VI collagen does not appear to be of greater importance for the increased trabecular outflow resistance in glaucoma patients than in normal eyes.     

Fibrillogenesis in tendon healing: an experimental study

The aim of this study was the histochemical, immunohistochemical and ultrastructural analysis of reparative fibrillogenesis in experimental lesions of Achilles' tendon. Subtotal tenotomy of Achilles' tendon was performed in twenty Wistar rats. The scar tissue was analysed 2, 4, 7, 14, 21, 30, 45 and 60 days post-operatively. Histochemical, (resorcin-fuchsin, aldehyde-fuchsin, iron haematoxylin and Fullmer and Lillie's methods) immunohistochemical (antibody against collagen I, II and elastin) and ultrastructural analyses were performed. Three phases in the healing process were distinguished: 1) inflammatory, 2) proliferative, and 3) remodelling phase. The inflammatory phase was characterised by haematoma, fibrin deposition, inflammatory cells, fibroblasts, beginning of collagen fibrillogenesis (200-400 A ? fibrils) and oxytalan fibrils. The proliferative phase was characterised by angiogenesis and fibroblast proliferation. Collagen fibres displayed a random arrangement and had a diameter of 400-600 A. Immature elastic fibres reached maximum tissutal concentration. In the remodelling phase, hypocellularity, normal vascularisation, tendon crimps, collagen fibres (800-1,000 A ?), elastic fibres with increased elastin deposition and reduction in oxytalan fibres were observed. In the course of the healing process collagen and elastic fibre fibrillogenesis exhibited consistent quantitative and qualitative variations (i.e. differences in the type and diameter of fibrils). The present study suggests that, together with other matrix macromolecules, also elastic fibres (oxytalan, elaunin and mature) are synthesised in significantly higher amounts during reparative fibrillogenesis and play a role in cell-matrix interaction.     

Anatomical mechanisms of continence in man

According to classical concepts, the role of the bladder sphincteric apparatus is to contain without weakness and to expel without effort. Continence without dysuria is the result of: biomechanical properties of the bladder wall which confer: viscoelasticity accounting for its compliance, contractility allowing expulsion of its contents. The action of bladder neck structures and passive urethral mechanisms which, under normal conditions, are practically sufficient to ensure passive continence. Muscle fibre tone collapses the urethra during the continence phase and closes the bladder neck by creating vesicourethral angulation. The arrangement of these muscle fibres in the bladder neck and urethra accounts for the sphincter function over the entire length of these two structures. The external sphincter composed of striated muscle fibres derived from perineal muscles, which are amenable to retraining. The main role of the sphincter under normal conditions is to oppose an unwanted bladder contraction or to rapidly interrupt ongoing micturition and it only has a relatively limited role in passive continence. It is particularly important after prostatic surgery, either for benign prostatic hyperplasia or for cancer, when the striated sphincter remains the only structure able to oppose the pressure forces which tend to expel urine from the bladder.     

Ultrastructure of the salivary bladder of the nine-banded armadillo

The nine-banded armadillo possesses a salivary bladder which is a dilated portion of the main duct of the submandibular gland at its origin. The wall of the bladder is composed of an epithelium, a submucosa and a thick coat of skeletal muscle. The ultrastructure of the epithelium reveals that it is complex and consists of three cell types: 1) principal cells, 2) light cells, and 3) basal cells. The general organization of the epithelium suggests that it is a transporting type of epithelium such as that found in the amphibian and reptilian and reptilian urinary bladders and the mammalian gall bladder. The submucosa is composed primarily of densely-packed collagen fibers. The skeletal muscle is very vascular and richly innervated.     

Clean intermittent catheterization for home management in children with myelomeningocele

Sixty-two children with myelomeningocele and neurogenic bladders have been managed with clean intermittent catheterization (CIC) at home for periods of 6 to 42 months. Abnormal upper urinary tracts improved or stabilized in 83 per cent of the children. There was no renal deterioration in children who began with normal upper tracts while on CIC. Bacteruria was common, but clinically not a problem, unless ureterovesical reflux was present. Urinary control was improved in 66 per cent of the children. CIC is an effective and safe method to regularly empty the urinary bladder and is an alternative to supravesical urinary diversion in many children with neurogenic bladders.     

High affinity binding sites for [3H]substance P in urinary bladders of cats with interstitial cystitis

PURPOSE: Pain is a common feature of interstitial cystitis (IC). Although the effects of IC on sensory neuron density have been investigated, its influence on substance P receptor (SPR) numbers and function are not well known. To evaluate the role of SPR in cats with IC, we measured the affinity (Kd), numbers (Bmax), and substrate specificity of binding sites for [3H]SP in urinary bladders of healthy cats and cats suffering from IC. MATERIALS & METHODS: Radioligand binding assays of cat and rat brain, normal cat bladders, and inflamed bladders from cats diagnosed with IC were conducted using [3H]SP to determine SPR affinity and numbers. Binding sites for [125I]SP were identified using autoradiography in slide-mounted frozen tissue sections, and their specificity determined with competition binding studies. RESULTS: In bladder homogenate binding studies, low affinity SP binding sites for [3H]SP were found both in normal and inflamed tissue, whereas high affinity binding sites were found in inflamed bladder tissue only. Based on autoradiographic studies, high affinity binding appeared to be to small blood vessels, and to be specific for substance P, a pharmacology consistent with the neurokinin-1 receptor (NK1R). CONCLUSIONS: Upregulation of NK1R may be part of the pathophysiology of IC, as it is in some other inflammatory diseases. If so, more specifically targeted therapies for IC may become available.     

A new method for cytodestruction of bladder epithelium using protamine sulfate and urea

Bladder epithelium relies primarily on the presence of a surface glycosaminoglycan (GAG) layer and the structural integrity of cell-cell contact to maintain impermeability to toxic urinary wastes. Previous clinical studies evaluating bladder permeability characteristics in interstitial cystitis patients had indicated that epithelial desquamation occurs after treatment with protamine sulfate (PS) followed by hypertonic urea. The following study was performed using rabbits to further investigate this finding. The urinary bladder was evaluated for optimal treatment conditions for epithelial removal. Protamine sulfate (1 to 10 mg./ml.) and urea (100 to 200 gm./ml.) were instilled into the bladder at volumes ranging from 5 to 60 ml. to that required for near maximum distention. After incubation at room temperature for 15 minutes, the bladders were fixed and evaluated histologically for epithelial removal. The maximum epithelial removal occurred when the bladders were distended, and when PS concentration was 5 to 10 mg./ml. and urea at 200 gm./l. There was greater epithelium removal after repeated treatments. Epithelial cells that were removed were not viable based on Trypan blue staining. There was no significant increase of C14 labeled urea in the plasma after 15 minutes. Rabbits that were followed for 6 weeks after treatment did not show any histological evidence of increased collagen deposition and/or fibrosis. This procedure may have important clinical value since it may remove sufficient bladder epithelium in patients with transitional cell carcinoma to have therapeutic benefit. This offers a realistic option for selective, nontoxic destruction of bladder epithelium.     

Lysosomal cysteine and aspartic proteinases and ubiquitin in rat and human urinary bladder epithelium

To examine localization of cysteine and aspartic proteinases, and ubiquitin in rat and human urinary bladders, immunocytochemistry was applied to the tissues. In semi-thin sections, immunoreactivity for cathepsins B and D was densely localized throughout epithelial layers of rats and humans, while that for cathepsins H and L was mainly localized in rat superficial and human intermediate cells. Immunoreactivity for cathepsin C was relatively high in rat and human epithelia, especially in humans. Immunoreactivity for ubiquitin was detected in rat and human epithelial cells. By electron microscopy, vesicular or heterogeneously dense lysosomes labeled with immunogold particles indicating cathepsin B were seen in rat and human epithelial cells; particularly, they often appeared near fusiform vesicles in rat superficial cells and in human intermediate and superficial cells. By double immunostaining, lysosomes with or without vesicular structures were co-labeled with immunogold particles showing both cathepsin B and ubiquitin. The results suggest that cathepsins B, C, H, and L, and cathepsin D are involved in the lysosomal system of rat and human bladder epithelia. Moreover, considering that ubiquitin is a cofactor in the soluble ATP-dependent proteolysis, the results may also indicate that epithelial cells actively form autophagolysosomes.