膀胱高濃度血小板血漿注射後,細胞增生、細胞骨架及屏障蛋白功能的改善

有助於反覆性泌尿道感染患者的尿路上皮恢復健康

李宇坤、郭漢崇

花蓮慈濟醫院 泌尿部

Improvement of cell proliferation, cytoskeleton and barrier function protein expression after platelet-rich plasma injection suggests improved urothelial health in the patients with intractable recurrent urinary tract infection

Yu Khun Lee, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan

Purpose:

We recently conducted a clinical study using autologous intraveiscal platelet-rich plasma (PRP) injections to treat patients with intractable recurrent urinary tract infection (UTI). This study investigated the changes of urothelial proliferation, cytoskeleton, and barrier function protein expression after PRP injections.

Materials and Methods:

Patients suffering from recurrent UTI even with antibiotics prophylaxis were enrolled. The patients underwent 4 monthly intravesical PRP injections and were followed up for 1 year. Patients undergoing anti-incontinence surgery served as controls. The patients with UTI recurrence less than twice within 1 year were considered successful. Bladder biopsies were performed at the first and fourth PRP injection. The bladder specimens were investigated by western blot for sonic hedgehog (Shh), CD34, tumor protein 63 (TP63), cytokeratin 5 (CK5), CK14, CK20, zonula occludens-1 (ZO-1), E-cadherin, inflammatory proteins tryptase and p38, apoptotic protein BAX and caspase-3, and functional protein M2, M3 and beta-3. GAPDH was used as normalizing protein for the quantification.

Results:

A total of 22 patients with recurrent UTI and 17 controls were enrolled. Fourteen of the 22 (63.6%) patients have successful outcome. Compared to the controls, the western blot quantification results showed recurrent UTI patients had lower CD34, TP63, CK20, M3, but higher CK5, BAX, and caspase-3 at baseline. The reduced CD34, CK20 and M3 expressions at baseline were significantly increased after repeat PRP injections. Patients with a successful outcome had significant increase of CD34, CK20, and decreased caspace-3 expressions after PRP injections.

Conclusions:

Our results showed intravesical PRP repeat injections could improve the urothelial cell proliferation and increase the umbrella cell number. The PRP injection might restore urothelial health and prevent UTI recurrence in the patient with intractable recurrent UTI.