Reviewing Interstitial Cystitis Models and Treatments: A Focus on the Urothelium

Author

Curam, Centre for Research in Medical Devices, National University of Ireland Galway, NUIGalway, Biosciences Research Building, 118 Corrib Village, Newcastle, Galway, Ireland

Abstract

Context: Interstitial cystitis is a multifactorial chronic and debilitating disease which is commonly associated with pain localized in the bladder region, increased urinary frequency, urgency and nocturia. Due to the high prevalence of pain in the population affected more recently the condition is often referred to as interstitial cystitis / bladder pain syndrome (IC/BPS).

Evidence Acquisition: Although IC presents with many different symptoms, researchers have formulated three different theories, which are not mutually exclusive, to explain IC pathology: the first is related to the alteration of the proteoglycan and protein junction composition, structure and presence in the urothelium. The second is an immune induced IC resulting from an increased number of activated mast cells in the bladder internal layers, such as detrusor muscle (DM), and mucosa/submucosa. The third type, which is closely related to the second one, is due to a sensory nerve sensitization as an effect of neurotrophic factors molecule release.

Results: Previous classification has been mirrored in the development of various in vitro and in vivo disease models created to mimic IC, as well as in the available therapies used to treat the condition to date. Conclusions: This review will summarize the most recent advances in the field, related to the different causative factors contributing to the development of the condition, the in vivo models used as well as the evidence they provide in advancing our knowledge and their limitations. The focus will be on works reporting on IC in the domain related to alterations in proteoglycans and cellular junction, specifically their composition, structure and appearance in the urothelium, and also discuss present and future therapies.

Conclusions: This review will summarize the most recent advances in the field, related to the different causative factors contributing to the development of the condition, the in vivo models used as well as the evidence they provide in advancing our knowledge and their limitations. The focus will be on works reporting on IC in the domain related to alterations in proteoglycans and cellular junction, specifically their composition, structure and appearance in the urothelium, and also discuss present and future therapies.

Keywords


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1.Clauw DJ, Schmidt M, Radulovic D, Singer A, Katz P, Bresette J. The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res. 1997;31(1):125-31. [PubMed: 9201654].
https://doi.org/10.1016/S0022-3956(96)00051-9
PMid:9201654
 
2. Oravisto KJ. Epidemiology of interstitial cystitis. Ann Chir Gynaecol Fenn. 1975;64(2):75-7. [PubMed: 1137336].
 
3. Lifford KL, Curhan GC. Prevalence of painful bladder syndrome in older women. Urology. 2009;73(3):494-8. [PubMed: 19118882].
https://doi.org/10.1016/j.urology.2008.01.053
PMid:19118882
 
4. Koziol JA. Epidemiology of interstitial cystitis. Urol Clin North Am. 1994;21(1):7-20. [PubMed: 8284848].
https://doi.org/10.1016/S0094-0143(21)00587-5
PMid:8284848
 
5. Gillenwater JY, Wein AJ. Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28- 29, 1987. J Urol. 1988;140(1):203-6. [PubMed: 3379688].
https://doi.org/10.1016/S0022-5347(17)41529-1
PMid:3379688
 
6. Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg LJ. The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol. 1999;161(2):553-7. [PubMed: 9915447].
https://doi.org/10.1016/S0022-5347(01)61948-7
PMid:9915447
 
7. Peeker R, Fall M. Treatment guidelines for classic and non-ulcer interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(1):23-32. [PubMed: 10738931].
https://doi.org/10.1007/s001920050006
PMid:10738931
 
8. Fall M, Logadottir Y, Peeker R. Interstitial cystitis is bladder pain syndrome with Hunner's lesion. Int J Urol. 2014;21 Suppl 1:79-82. [PubMed: 24807507].
https://doi.org/10.1111/iju.12325
PMid:24807507
 
9. Hand JR. Interstitial cystitis; report of 223 cases (204 women and 19 men). J Urol. 1949;61(2):291-310. [PubMed: 18111850].
https://doi.org/10.1016/S0022-5347(17)69067-0
PMid:18111850
 
10. Chennamsetty A, Ehlert MJ, Peters KM, Killinger KA. Advances in diagnosis and treatment of interstitial cystitis/painful bladder syndrome. Curr Infect Dis Rep. 2015;17(1):454. [PubMed: 25416849].
https://doi.org/10.1007/s11908-014-0454-5
PMid:25416849
 
11. Chelimsky G, Heller E, Buffington CA, Rackley R, Zhang D, Chelimsky T. Co-morbidities of interstitial cystitis. Front Neurosci. 2012;6:114. [PubMed: 22907988].
https://doi.org/10.3389/fnins.2012.00114
PMid:22907988 PMCid:PMC3415690
 
12. Griffiths D, Hofner K, van Mastrigt R, Rollema HJ, Spangberg A, Gleason D. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn. 1997;16(1):1-18. [PubMed: 9021786].
https://doi.org/10.1002/(SICI)1520-6777(1997)16:1<1::AID-NAU1>3.0.CO;2-I
 
13. Birder L, Andersson KE. Urothelial signaling. Physiol Rev. 2013;93(2):653-80. [PubMed: 23589830].
https://doi.org/10.1152/physrev.00030.2012
PMid:23589830 PMCid:PMC3768101
 
14. Apodaca G. The uroepithelium: not just a passive barrier. Traffic. 2004;5(3):117-28. [PubMed: 15086788].
https://doi.org/10.1046/j.1600-0854.2003.00156.x
PMid:15086788
 
15. Sun TT. Altered phenotype of cultured urothelial and other stratified epithelial cells: implications for wound healing. Am J Physiol Renal Physiol. 2006;291(1):F9-21. [PubMed: 16609152]. 12 Razavi Int J Med. 2017; 5(4):e64551. Federico F
https://doi.org/10.1152/ajprenal.00035.2006
PMid:16609152
 
16. Hicks RM. The mammalian urinary bladder: an accommodating organ. Biol Rev Camb Philos Soc. 1975;50(2):215-46. [PubMed: 1100129].
https://doi.org/10.1111/j.1469-185X.1975.tb01057.x
PMid:1100129
 
17. Hurst RE, Roy JB, Min KW, Veltri RW, Marley G, Patton K, et al. A deficit of chondroitin sulfate proteoglycans on the bladder uroepithelium in interstitial cystitis. Urology. 1996;48(5):817-21. [PubMed: 8911536].
https://doi.org/10.1016/S0090-4295(96)00322-6
PMid:8911536
 
18. Theoharides TC, Kempuraj D, Sant GR. Mast cell involvement in interstitial cystitis: a review of human and experimental evidence. Urology. 2001;57(6 Suppl 1):47-55. [PubMed: 11378050].
https://doi.org/10.1016/S0090-4295(01)01129-3
PMid:11378050
 
19. Kreft ME, Romih R, Kreft M, Jezernik K. Endocytotic activity of bladder superficial urothelial cells is inversely related to their differentiation stage. Differentiation. 2009;77(1):48-59. [PubMed: 19281764].
https://doi.org/10.1016/j.diff.2008.09.011
PMid:19281764
 
20. Cox PJ. Cyclophosphamide cystitis-identification of acrolein as the causative agent. Biochem Pharmacol. 1979;28(13):2045-9. [PubMed: 475846].
https://doi.org/10.1016/0006-2952(79)90222-3
PMid:475846
 
21. Cox PJ, Abel G. Cyclophosphamide cystitis. Studies aimed at its minimization. Biochem Pharmacol. 1979;28(24):3499-502. [PubMed: 231445].
https://doi.org/10.1016/0006-2952(79)90390-3
PMid:231445
 
22. Batista CK, Brito GA, Souza ML, Leitao BT, Cunha FQ, Ribeiro RA. A model of hemorrhagic cystitis induced with acrolein in mice. Braz J Med Biol Res. 2006;39(11):1475-81. [PubMed: 17146560].
https://doi.org/10.1590/S0100-879X2006005000024
PMid:17146560
 
23. Tzan CJ, Berg J, Lewis SA. Effect of protamine sulfate on the permeability properties of the mammalian urinary bladder. J Membr Biol. 1993;133(3):227-42. [PubMed: 8331646].
https://doi.org/10.1007/BF00232022
PMid:8331646
 
24. Lavelle J, Meyers S, Ramage R, Bastacky S, Doty D, Apodaca G, et al. Bladder permeability barrier: recovery from selective injury of surface epithelial cells. Am J Physiol Renal Physiol. 2002;283(2):F242-53. Shimizu I, Kawashima K, Hosoki K. Urodynamics in acetone-induced cystitis of anesthetized rats. Neurourol Urodyn. 1999;18(2):115-27. [PubMed: 10081951].
https://doi.org/10.1152/ajprenal.00307.2001
PMid:12110507
 
25. Keay S, Leitzell S, Ochrzcin A, Clements G, Zhan M, Johnson D. Amouse model for interstitial cystitis/painful bladder syndrome based on APF inhibition of bladder epithelial repair: a pilot study. BMC Urol. 2012;12:17. [PubMed: 22682521].
https://doi.org/10.1186/1471-2490-12-17
PMid:22682521 PMCid:PMC3459789
 
26. Lv YS, Yao YS, Rong L, Lin ME, Deng BH, Xie Y, et al. Intravesical hyaluronidase causes chronic cystitis in a rat model: a potential model of bladder pain syndrome/interstitial cystitis. Int J Urol. 2014;21(6):601-7. [PubMed: 24286489].
https://doi.org/10.1111/iju.12358
PMid:24286489
 
27. Oottamasathien S, Jia W, McCoard L, Slack S, Zhang J, Skardal A, et al. A murine model of inflammatory bladder disease: cathelicidin peptide induced bladder inflammation and treatment with sulfated polysaccharides. J Urol. 2011;186(4 Suppl):1684-92. [PubMed: 21855919].
https://doi.org/10.1016/j.juro.2011.03.099
PMid:21855919 PMCid:PMC3887035
 
28. Elbadawi A. Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology. 1997;49(5A Suppl):14-40. [PubMed: 9145999].
https://doi.org/10.1016/S0090-4295(99)80329-X
PMid:9145999
 
29. Galli SJ. New concepts about the mast cell. N Engl J Med. 1993;328(4):257-65. [PubMed: 8418407].
https://doi.org/10.1056/NEJM199301283280408
PMid:8418407
 
30. Bullock AD, Becich MJ, Klutke CG, Ratliff TL. Experimental autoimmune cystitis: a potential murine model for ulcerative interstitial cystitis. J Urol. 1992;148(6):1951-6. [PubMed: 1433651].
https://doi.org/10.1016/S0022-5347(17)37091-X
PMid:1433651
 
31. Lin YH, Liu G, Kavran M, Altuntas CZ, Gasbarro G, Tuohy VK, et al. Lower urinary tract phenotype of experimental autoimmune cystitis in mouse: a potential animal model for interstitial cystitis. BJU Int. 2008;102(11):1724-30. [PubMed: 18710451].
https://doi.org/10.1111/j.1464-410X.2008.07891.x
PMid:18710451
 
32. Luber-Narod J, Austin-Ritchie T, Banner B, Hollins C3, Maramag C, Price H, et al. Experimental autoimmune cystitis in the Lewis rat: a potential animal model for interstitial cystitis. Urol Res. 1996;24(6):367- 73. [PubMed: 9008331].
https://doi.org/10.1007/BF00389795
PMid:9008331
 
33. Ratliff TL, Klutke CG, Hofmeister M, He F, Russell JH, Becich MJ. Role of the immune response in interstitial cystitis. Clin Immunol Immunopathol. 1995;74(3):209-16. [PubMed: 7859410].
https://doi.org/10.1006/clin.1995.1031
PMid:7859410
 
34. Altuntas CZ, Daneshgari F, Sakalar C, Goksoy E, Gulen MF, Kavran M, et al. Autoimmunity to uroplakin II causes cystitis in mice: a novel model of interstitial cystitis. Eur Urol. 2012;61(1):193-200.. [PubMed: 21719190].
https://doi.org/10.1016/j.eururo.2011.06.028
PMid:21719190 PMCid:PMC3226908
 
35. Lavelle JP, Apodaca G, Meyers SA, Ruiz WG, Zeidel ML. Disruption of guinea pig urinary bladder permeability barrier in noninfectious cystitis. Am J Physiol. 1998;274(1 Pt 2):F205-14. [PubMed: 9458841].
https://doi.org/10.1152/ajprenal.1998.274.1.F205
PMid:9458841
 
36. Ercan F, San T, Cavdar S. The effects of cold-restraint stress on urinary bladder wall compared with interstitial cystitis morphology. Urol Res. 1999;27(6):454-61. [PubMed: 10651134].
https://doi.org/10.1007/s002400050135
PMid:10651134
 
37. Lai H, Gereau R, Luo Y, O'Donnell M, Rudick CN, Pontari M, et al. Animal Models of Urologic Chronic Pelvic Pain Syndromes: Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network. Urology. 2015;85(6):1454-65. [PubMed: 26099889].
https://doi.org/10.1016/j.urology.2015.03.007
PMid:26099889 PMCid:PMC4479414
 
38. Cruz F. The future of pharmacologic treatment for bladder pain syndrome/interstitial cystitis: lessons from a meta-analysis. Eur Urol. 2012;61(1):54-5. [PubMed: 21975250] discussion 56-7.
https://doi.org/10.1016/j.eururo.2011.09.015
PMid:21975250
 
39. Nazif O, Teichman JM, Gebhart GF. Neural upregulation in interstitial cystitis. Urology. 2007;69(4 Suppl):24-33. [PubMed: 17462476].
https://doi.org/10.1016/j.urology.2006.08.1108
PMid:17462476
 
40. Spanos C, el-Mansoury M, Letourneau R, Minogiannis P, Greenwood J, Siri P, et al. Carbachol-induced bladder mast cell activation: augmentation by estradiol and implications for interstitial cystitis. Urology. 1996;48(5):809-16. [PubMed: 8911535].
https://doi.org/10.1016/S0090-4295(96)00239-7
PMid:8911535
 
41. Jerde TJ, Bjorling DE, Steinberg H, Warner T, Saban R. Determination of mouse bladder inflammatory response to E. coli lipopolysaccharide. Urol Res. 2000;28(4):269-73. [PubMed: 11011967].
https://doi.org/10.1007/s002400000114
PMid:11011967
 
42. Jasmin L, Janni G, Manz HJ, Rabkin SD. Activation of CNS circuits producing a neurogenic cystitis: evidence for centrally induced peripheral inflammation. J Neurosci. 1998;18(23):10016-29. [PubMed: 9822756].
https://doi.org/10.1523/JNEUROSCI.18-23-10016.1998
PMid:9822756 PMCid:PMC6793287
 
43. Rudick CN, Schaeffer AJ, Klumpp DJ. Pharmacologic attenuation of pelvic pain in a murine model of interstitial cystitis. BMC Urol. 2009;9:16. [PubMed: 19909543].
https://doi.org/10.1186/1471-2490-9-16
PMid:19909543 PMCid:PMC2781023
 
44. Pontari MA. Seeking A Rational Approach to the Diagnosis and Treatment of Interstitial Cystitis. Medscape Womens Health. 1996;1(5):2. [PubMed: 9746627].
 
45. Warren JW. Bladder pain syndrome/interstitial cystitis as a functional somatic syndrome. J Psychosom Res. 2014;77(6):510-5. [PubMed: 25455811].
https://doi.org/10.1016/j.jpsychores.2014.10.003
PMid:25455811
 
46. Persu C, Cauni V, Gutue S, Blaj I, Jinga V, Geavlete P. From interstitial cystitis to chronic pelvic pain. J Med Life. 2010;3(2):167-74. [PubMed: 20968203].
 
47. Theoharides TC, Pang X, Letourneau R, Sant GR. Interstitial cystitis: a neuroimmunoendocrine disorder. Ann N Y Acad Sci. 1998;840:619-34. [PubMed: 9629289].
https://doi.org/10.1111/j.1749-6632.1998.tb09601.x
PMid:9629289
 
48. Soler R, Bruschini H, Truzzi JC, Martins JR, Camara NO, Alves MT, et al. Urinary glycosaminoglycans excretion and the effect of dimethyl sulfoxide in an experimental model of non-bacterial cystitis. Int Braz J Urol. 2008;34(4):503-11. [PubMed: 18778502] discussion 511.
https://doi.org/10.1590/S1677-55382008000400013
PMid:18778502
 
49. Santos NC, Figueira-Coelho J, Martins-Silva J, Saldanha C. Multidisciplinary utilization of dimethyl sulfoxide: pharmacological, cellular, and molecular aspects. Biochem Pharmacol. 2003;65(7):1035-41. [PubMed: 12663039].
https://doi.org/10.1016/S0006-2952(03)00002-9
PMid:12663039
 
50. Smith KJ, Chess-Williams R, McDermott C. Luminal DMSO: effects on detrusor and urothelial/lamina propria function. Biomed Res Int. Razavi Int J Med. 2017
 
5(4):e64551. 13 Federico F 2014;2014:347616. [PubMed: 24949435].
 
51. Tomoe H. In what type of interstitial cystitis/bladder pain syndrome is DMSO intravesical instillation therapy effective? Transl Androl Urol. 2015;4(6):600-4. [PubMed: 26816859].
 
52. Parsons CL, Koziol JA, Proctor JG, Zupkas P, Argade S. Heparin and alkalinized lidocaine versus alkalinized lidocaine for treatment of interstitial cystitis symptoms. Can J Urol. 2015;22(2):7739-44. [PubMed: 25891339].
 
53. Parsons CL, Forrest J, Nickel JC, Evans R, Lloyd LK, Barkin J, et al. Effect of pentosan polysulfate therapy on intravesical potassium sensitivity. Urology. 2002;59(3):329-33. [PubMed: 11880064].
https://doi.org/10.1016/S0090-4295(01)01586-2
PMid:11880064
 
54. Kalota SJ, Stein PC, Parsons CL. Prevention of acrolein-induced bladder injury by pentosanpolysulfate. J Urol. 1992;148(1):163-6. [PubMed: 1377288].
https://doi.org/10.1016/S0022-5347(17)36545-X
PMid:1377288
 
55. Chiang G, Patra P, Letourneau R, Jeudy S, Boucher W, Green M, et al. Pentosanpolysulfate inhibits mast cell histamine secretion and intracellular calcium ion levels: an alternative explanation of its beneficial effect in interstitial cystitis. J Urol. 2000;164(6):2119-25. [PubMed: 11061939].
https://doi.org/10.1016/S0022-5347(05)66981-9
PMid:11061939
 
56. Kelly JD, Young MR, Johnston SR, Keane PF. Clinical response to an oral prostaglandin analogue in patients with interstitial cystitis. Eur Urol. 1998;34(1):53-6. [PubMed: 9676414].
https://doi.org/10.1159/000019679
PMid:9676414
 
57. Kuschert GS, Coulin F, Power CA, Proudfoot AE, Hubbard RE, Hoogewerf AJ, et al. Glycosaminoglycans interact selectively with chemokines and modulate receptor binding and cellular responses. Biochemistry. 1999;38(39):12959-68. [PubMed: 10504268].
https://doi.org/10.1021/bi990711d
PMid:10504268
 
58. Stern R. Hyaluronan catabolism: a new metabolic pathway. Eur J Cell Biol. 2004;83(7):317-25. [PubMed: 15503855].
https://doi.org/10.1078/0171-9335-00392
PMid:15503855
 
59. Sinanoglu O, Dogan Ekici I, Ekici S. Comparison of intravesical application of chondroitin sulphate and colchicine in rat protamine/lipopolysaccharide induced cystitis model. Urol J. 2014;11(1):1296-300. [PubMed: 24595940].
 
60. Eggli PS, Graber W. Cytochemical localization of hyaluronan in rat and human skin mast cell granules. J Invest Dermatol. 1993;100(2):121- 5. [PubMed: 8429234].
https://doi.org/10.1111/1523-1747.ep12462777
PMid:8429234
 
61. Fiander N. Painful bladder syndrome and interstitial cystitis: treatment options. Br J Nurs. 2013;22(9):S26. [PubMed: 23752572] S28-33.
 
62. Toole BP. Hyaluronan and its binding proteins, the hyaladherins. Curr Opin Cell Biol. 1990;2(5):839-44. [PubMed: 1707285].
https://doi.org/10.1016/0955-0674(90)90081-O
PMid:1707285
 
63. Shao Y, Lu GL, Shen ZJ, He HC. Reduction of intercellular adhesion molecule 1 may play a role in anti-inflammatory effect of hyaluronic acid in a rat model of severe non-bacterial cystitis. World J Urol. 2013;31(3):535-40. [PubMed: 22358112].
https://doi.org/10.1007/s00345-012-0839-8
PMid:22358112
 
64. Arance I, Ramon de Fata F, Angulo JC, Gonzalez-Enguita C, Errando C, Cozar JM, et al. [Available evidence about efficacy of different restoring agents of glycosaminoglycans for intravesical use in interstitial cystitis]. Actas Urol Esp. 2013;37(2):92-9. [PubMed: 23260184].
https://doi.org/10.1016/j.acuroe.2013.05.001
 
65. Negrete HO, Lavelle JP, Berg J, Lewis SA, Zeidel ML. Permeability properties of the intact mammalian bladder epithelium. Am J Physiol. 1996;271(4 Pt 2):F886-94. [PubMed: 8898019].
https://doi.org/10.1152/ajprenal.1996.271.4.F886
PMid:8898019
 
66. Kaufman J, Tyagi V, Anthony M, Chancellor MB, Tyagi P. State of the art in intravesical therapy for lower urinary tract symptoms. Rev Urol. 2010;12(4):e181-9. [PubMed: 21234261].
 
67. Tyagi P, Chancellor M, Yoshimura N, Huang L. Activity of different phospholipids in attenuating hyperactivity in bladder irritation. BJU Int. 2008;101(5):627-32. [PubMed: 18070198].
https://doi.org/10.1111/j.1464-410X.2007.07334.x
PMid:18070198
 
68. Nirmal J, Tyagi P, Chancellor MB, Kaufman J, Anthony M, Chancellor DD, et al. Development of potential orphan drug therapy of intravesical liposomal tacrolimus for hemorrhagic cystitis due to increased local drug exposure. J Urol. 2013;189(4):1553-8. [PubMed: 23127767].
https://doi.org/10.1016/j.juro.2012.10.123
PMid:23127767
 
69. Shao Y, Shen ZJ, Rui WB, Zhou WL. Intravesical instillation of hyaluronic acid prolonged the effect of bladder hydrodistention in patients with severe interstitial cystitis. Urology. 2010;75(3):547-50. [PubMed: 20022087].
https://doi.org/10.1016/j.urology.2009.09.078
PMid:20022087
 
70. Lv YS, Zhou HL, Mao HP, Gao R, Wang YD, Xue XY. Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2012;23(12):1715-20. [PubMed: 22576327].
https://doi.org/10.1007/s00192-012-1802-3
PMid:22576327
 
71. Giberti C, Gallo F, Cortese P, Schenone M. Combined intravesical sodium hyaluronate/chondroitin sulfate therapy for interstitial cystitis/bladder pain syndrome: a prospective study. Ther Adv Urol. 2013;5(4):175-9. [PubMed: 23904856].
https://doi.org/10.1177/1756287213490052
PMid:23904856 PMCid:PMC3721440
 
72. Song M, Lim J, Yu HY, Park J, Chun JY, Jeong J, et al. Mesenchymal Stem Cell Therapy Alleviates Interstitial Cystitis by Activating Wnt Signaling Pathway. Stem Cells Dev. 2015;24(14):1648-57. [PubMed: 25745847].
https://doi.org/10.1089/scd.2014.0459
PMid:25745847 PMCid:PMC4499842
 
73. Zhang J, Planey SL, Ceballos C, Stevens SJ, Keay SK, Zacharias DA. Identification of CKAP4/p63 as a major substrate of the palmitoyl acyltransferase DHHC2, a putative tumor suppressor, using a novel proteomics method. Mol Cell Proteomics. 2008;7(7):1378-88. [PubMed: 18296695].
https://doi.org/10.1074/mcp.M800069-MCP200
PMid:18296695 PMCid:PMC2493380
 
74. Yang W, Chung YG, Kim Y, Kim TK, Keay SK, Zhang CO, et al. Quantitative proteomics identifies a beta-catenin network as an element of the signaling response to Frizzled-8 protein-related antiproliferative factor. Mol Cell Proteomics. 2011;10(6):M110 007492. [PubMed: 21422242].
https://doi.org/10.1074/mcp.M110.007492
PMid:21422242 PMCid:PMC3108841
 
75. Shahjee HM, Koch KR, Guo L, Zhang CO, Keay SK. Antiproliferative factor decreases Akt phosphorylation and alters gene expression via CKAP4 in T24 bladder carcinoma cells. J Exp Clin Cancer Res. 2010;29:160.. [PubMed: 21143984].
https://doi.org/10.1186/1756-9966-29-160
PMid:21143984 PMCid:PMC3020166
 
76. Tao YX, Heit M, Lei ZM, Rao CV. The urinary bladder of a woman is a novel site of luteinizing hormone-human chorionic gonadotropin receptor gene expression. Am J Obstet Gynecol. 1998;179(4):1026-31. [PubMed: 9790392].
https://doi.org/10.1016/S0002-9378(98)70222-4
PMid:9790392
 
77. Rao CV. Therapeutic Potential of Human Chorionic Gonadotropin Against Painful Bladder Syndrome/Interstitial Cystitis. Reprod Sci. 2016;23(11):1451-8. [PubMed: 27004802].
https://doi.org/10.1177/1933719116639139
PMid:27004802
 
78. Barthelmes J, Perera G, Hombach J, Dunnhaupt S, Bernkop-Schnurch A. Development of a mucoadhesive nanoparticulate drug delivery system for a targeted drug release in the bladder. Int J Pharm. 2011;416(1):339-45. [PubMed: 21726619]
https://doi.org/10.1016/j.ijpharm.2011.06.033
PMid:21726619