It is estimated that 100 million men and women are affected by urinary incontinence (UI). The prevalence of UI is generally higher in women than in men, women being between two (older age groups) and four times (younger and middle-aged) more likely to be incontinent than men. Hormone replacement has been the mainstay of medical therapy for women with urinary incontinence for several decades. However, two recently published long-term studies involving thousands of women showed that estrogen/progesterone therapy increased the incontinence rate. We have developed a rat model of stress urinary incontinence (SUI) and have since been actively involved in the study of female SUI. To investigate the hormonal effect on urinary incontinence, we treated our rat SUI models with placebo versus estrogen pellet. Consistent with the results of human studies mentioned above, our pilot study showed that estrogen treatment increased the rate of SUI. We went on to study the possible mechanism of this phenomenon and found that estrogen has differential effects on the vagina and urethra. We hypothesize that the relaxant effect of estrogen on the urethra contributes to the increase incontinence rate particularly in those women who already have """"""""compromised"""""""" continence mechanism. We also hypothesize that better treatment options can be identified by studying the effect of selective estrogen receptor modulators (SERMs) as well as several known trophic factors for muscle and nerve. The hypotheses will be tested by completing the following specific aims. Our long term goal is to find better preventive and therapeutic measures for women with urinary incontinence.
Specific Aim 1. To identify the effect of sex hormones and SERMs on female urinary continence. This will be accomplished by treating our established incontinence rat model with estrogen, progesterone, raloxifene, levormeloxifene, and growth hormone, followed by cystometrical analysis.
Specific Aim 2. To elucidate the molecular mechanism associated with estrogen/progesterone induced incontinence. This will be accomplished by examining the urethra, bladder, vagina, and pelvic floor muscles for possible changes in myosin light chain phosphorylation, rho kinase expression, and VEGF promoter activity.
Specific Aim 3. To identify better preventive and therapeutic options for stress urinary incontinence. This will be accomplished first by establishing primary urethra smooth muscle cell cultures and paracervical ganglion neurons from various groups of rats as in Specific Aim 1. The cell and ganglial cultures will be treated with estradiol, raloxifene, testosterone, and various growth factors, and analyzed for cell proliferation and neurite growth.
Specific Aim 4. To identify the molecular mechanism through which estrogen modulates the expression of a1A adrenoceptor. This will be accomplished by analyzing various promoter constructs of the rat a1A adrenoceptor gene in the presence of estrogen and SERMs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK069655-04
Application #
7368081
Study Section
Special Emphasis Panel (ZRG1-RUS-B (03))
Program Officer
Kusek, John W
Project Start
2005-04-01
Project End
2010-02-28
Budget Start
2008-03-01
Budget End
2009-02-28
Support Year
4
Fiscal Year
2008
Total Cost
$288,592
Indirect Cost
Name
University of California San Francisco
Department
Urology
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Zhang, Xiaoyu; Alwaal, Amjad; Lin, Guiting et al. (2016) Urethral musculature and innervation in the female rat. Neurourol Urodyn 35:382-9
Lin, Guiting; Alwaal, Amjad; Sun, Fionna et al. (2015) Estrogen attenuates TGF-?1 induced elastogenesis in rat urethral smooth muscle cells by inhibiting Smad response elements. J Urol 193:2131-7
Ning, Hongxiu; Lei, Hong-En; Xu, Yong-De et al. (2014) Conversion of adipose-derived stem cells into natural killer-like cells with anti-tumor activities in nude mice. PLoS One 9:e106246
Lin, Ching-Shwun; Lue, Tom F (2013) Defining vascular stem cells. Stem Cells Dev 22:1018-26
Lin, Ching-Shwun; Albersen, Maarten; Xin, Zhongcheng et al. (2013) Phosphodiesterase-5 expression and function in the lower urinary tract: a critical review. Urology 81:480-7
Lin, Ching-Shwun; Xin, Zhong-Cheng; Dai, Jican et al. (2013) Commonly used mesenchymal stem cell markers and tracking labels: Limitations and challenges. Histol Histopathol 28:1109-16
Qiu, Xuefeng; Lin, Guiting; Xin, Zhongcheng et al. (2013) Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med 10:738-46
Lin, Ching-Shwun; Lue, Tom F (2013) Words of wisdom: re: characterization of the early proliferative response of the rodent bladder to subtotal cystectomy: a unique model of mammalian organ regeneration. Eur Urol 63:401-2
Lin, C-S; Xin, Z; Namiki, M et al. (2013) Direct androgen regulation of PDE5 gene or the lack thereof. Int J Impot Res 25:81-5
Ning, Hongxiu; Albersen, Maarten; Lin, Guiting et al. (2013) Effects of EdU labeling on mesenchymal stem cells. Cytotherapy 15:57-63

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