THE MORPHOLOGICAL FEATURES AND EXPRESSION OF TLR4 AND CD117 IN CHRONIC CYSTITIS AND RESISTANT OVERACTIVE BLADDER IN WOMEN


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Abstract

Objective. To compare the clinical, morphological, and immunohistochemical characteristics of resistant overactive bladder (OAB) and chronic cystitis in reproductive-aged and perimenopausal women. Subject and methods. Sixteen bladder wall biopsy specimens obtained from women with clinically verified chronic cystitis during standard cystoscopy with bladder wall biopsy and 14 from those with OAB. The patients’ mean age was 40.6±10.4years. In the group of patients with OAB and chronic cystitis, the mean age was 38.0±5.4 and 41.8±2.3 years, respectively. The biopsy specimens were morphologically examined and immunohistochemical markers (CD177 and TLR4) were studied. Results. The morphological examination of the biopsy specimens in the group of clinically verified cystitis, they generally displayed the surface layers of the bladder mucosa covered with the laminated squamous epithelium (LSE) with the signs of atrophy; the underlying stroma showed diffuse lymphoplasmacytic infiltration, sclerosis, hyaline degeneration of vessel walls, and hyperemia of muscle fibers. In the OAB group, there was an excellent histological pattern: the bladder mucosa was covered by the multirowed epithelium (MRE) or LSE hyperkeratosis; the submucosal layer exhibited edema, sclerosis, thin-walled vessels, focal inflammatory infiltration, as well as there was focal hypertrophy of muscle fibers. The investigation revealed significant differences in the magnitude of some morphological parameters: atrophy of the epithelium and that of the muscular layer were more pronounced in patients with chronic cystitis (p < 0.001), stromal edema (p < 0.06), and muscle layer hypertrophy (p < 0.001) in the OAB group. In the evaluation of the immunohistochemical expression of TLR4, the latter was as brown staining of epithelial cytoplasm, inflammatory cell infiltrate and in the cell cytoplasm of the vascular endothelium. Evaluation of CD117 expression in the stromal inflammatory infiltrate showed the high cellular accumulation of the marker in both groups; however, there was a tendency towards the higher expression of the marker. Conclusion. The f indings strengthen the hypothesis that OAB is inflammatory in genesis. Furthermore, analysis of the immunohistochemical expression of CD117 has shown that the stromal inflammatory infiltrate cells have high concentrations of the marker in the OAB and chronic cystitis group. This confirms the theory that due to pacemaker function, it is precisely these cells that provide spontaneous myogenic activity of their surrounding smooth muscle cells and give rise to their hypertrophy.

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About the authors

Tatiana Aleksandrovna DEMURA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University

Email: uursula90@gmail.com
associate professor, PhD, Senior Researcher of the 1st Pathology department 117997, Russia, Moscow, Ac. Oparina str. 4

Tatiana Aleksandrovna TETERINA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: palpebra@inbox.ru
Graduate 117997, Russia, Moscow, Ac. Oparina str. 4

Inna Anatolievna APOLIKHINA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University

Email: apolikhina@inbox.ru
professor, PhD, MD, Head of Gynecological rehabilitation department and one - day clinic 117997, Russia, Moscow, Ac. Oparina str. 4

Evgenia Aleksandrovna KOGAN

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: koganev@gmail.com
professor, PhD, MD, Head of the 1st Pathology department 117997, Russia, Moscow, Ac. Oparina str. 4

Gennadiy Dmitrievich EFREMOV

Research Institute of Urology, Ministry of Health of Russia

Email: efremov.gen@yandex.ru
Head of the Laboratory of Pathological Anatomy 117997, Russia, Moscow, Ac. Oparina str. 4

Petr Vitalievich GLYBOCHKO

I.M. Sechenov First Moscow State Medical University

professor, PhD, MD, Rector 117997, Russia, Moscow, Ac. Oparina str. 4

Gennadiy Tikhonovich SUKHIKH

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University

Email: g_sukhikh@oparina4.ru
professor, PhD, MD, Head; Head of the obstetrician, gynecological, perinatological and reproductive department 117997, Russia, Moscow, Ac. Oparina str. 4

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