Overactive bladder (OAB) is considered to be a disorder of the urinary bladder and is defined by the International Continence Society Terminology Committee as "urgency, with or without urge incontinence, usually with frequency and nocturia". There is some preliminary evidence using functional magnetic resonance imaging (fMRI) that the brain response to bladder filling in OAB patients is abnormal. The purpose of this research is to determine whether there are Central Nervous System (CNS) differences in modulating bladder function that contribute to, or are themselves the cause of the symptoms in OAB patients. We further investigated the pharmacological fMRI changes / Electrical and Computer Engineering

No / The indolequinone EO9 demonstrated good preclinical activity but failed to show clinical efficacy against a range of tumours following intravenous drug administration. A significant factor in EO9's failure in the clinic has been attributed to its rapid pharmacokinetic elimination resulting in poor drug delivery to tumours. Intravesical administration of EO9 would circumvent the problem of drug delivery to tumours and the principal objective of this study is to determine whether or not bladder tumours have elevated levels of the enzyme NQO1 (NAD(P)H:quinone oxidoreductase) which plays a key role in activating EO9 under aerobic conditions. Elevated NQO1 levels in human bladder tumour tissue exist in a subset of patients as measured by both immunohistochemical and enzymatic assays. In a panel of human tumour cell lines, EO9 is selectively toxic towards NQO1 rich cell lines under aerobic conditions and potency can be enhanced by reducing extracellular pH. These studies suggest that a subset of bladder cancer patients exist whose tumours possess the appropriate biochemical machinery required to activate EO9. Administration of EO9 in an acidic vehicle could be employed to reduce possible systemic toxicity as any drug absorbed into the blood stream would become relatively inactive due to an increase in pH.

Yes / The aim of this study was to assess the feasibility of a randomized controlled trial (PFM) treatment in women with bladder pain syndrome (BPS). Prolonged PFM tension contributes to the bladder pain, urinary frequency and urgency associated with BPS. Pelvic health physiotherapists routinely provide intravaginal myofascial release (MFR) to the PFMs in order to effectively reduce symptoms. Rapid access A TW was designed so as to allow men with chronic pelvic pain to self- treat, and this may be effective in women with BPS. For 6 weeks, two groups received weekly physiotherapist- provided MFR, and were monitored for a further 6- week follow- up period. One group also used a TW at home three times a week throughout the pilot. Weekly outcome measures of BPS symptoms and quality of life were recorded. A clinically meaningful difference in Interstitial Cystitis Symptoms Index and Interstitial Cystitis Problem Index score changes between groups was group = 6.20 ± 0.83 and 5.00 ± 1.41, respectively), and a difference was observed during the follow- up period (control group = 4.50 ± 1.73 and 4.00 ± 2.44, respecevents. Using the TW appears to have enhanced physiotherapy treatment during the initial 6 weeks, and improved symptoms during the 6- week follow- up period. The TW may be a clinically useful tool for long- term management of BPS. The feasibility of the study method was proven, some alterations were recommended and an RCT is now warranted.

Background and Purpose: Primary nocturnal enuresis (PNE) is a heterogeneous disorder with various underlying pathophysiological mechanisms. Results of our recent studies focused on the relationship of bladder function, sleep and brain function demonstrated a simultaneous occurrence of bladder and brain dysfunction in children with severe refractory PNE. We therefore proposed to use an animal model with altered bladder function to evaluate if abnormalities in bladder function induce functional derangement in brainstem micturition centers and/or sleep-arousal centers. / Materials and methods: In general, the study was divided in to 6 parts. Male Wistar rats (~ 1.5 months) were used for the study. / Study I: Establishment of animal model —— Male Wistar rats (200-220 g) underwent either Sham surgery or surgical reduction of bladder volume (RBV). Animals were used for further Cystometry, EEG, MRS and Cognitive function studies 4-5 weeks postoperatively. / Study II: Conventional Fill Cystometry (CFC) to evaluate bladder functional changes in response to surgical bladder volume reduction —— Twenty-four rats (RBV=12, SHAM 12) were used for the study. CFC was performed under conscious condition for evaluating the functional changes in response to surgical bladder capacity reduction. / Study III: Radiotelemetered EEG study to assess the impact of bladder dysfunction on sleep architecture and cortical arousals in rats —— Twenty-four rats (RBV=12, SHAM 12) were used for the study. Radiotelemeters were implanted in both groups 4 weeks post-operatively. The EEG biopotential and bladder pressure were monitored for 48 hours. Sleep architecture and cortical arousals were then evaluated manually. / Study IV: Evaluation of cognitive function following surgical bladder volume reduction —— Ninety eight rats (RBV=50, SHAM =48) were used for the study. / Morris Water Maze task: A circular plastic translucent pool half-filled with 26 ± 2ºC water, was used in the Morris Animals were given 9 consecutive training (2/day) sessions of Morris Water Maze (MWM) at 4 weeks postoperatively. / 8-arm Radial Maze: Food pellets were randomly placed inside each arm of the maze and the rats were allowed to explore the maze freely for 5 minutes. The rat was allowed to explore the maze for 5 minutes. Total time spent in each arm, total distance traveled in the maze was recorded. / Study V: Magnetic Resonance Spectroscopy to detect functional changes in brain in response to bladder dysfunction elicited by surgical bladder volume reduction —— Proton magnetic resonance spectroscopy was employed to examine brain metabolic changes in 24 rats (RBV=12, SHAM=12). Single voxel 1 H MRS experiments were performed using a 7 T MRI scanner. MR spectra were then processed using the jMRUI software. / Phase VI: Enzyme -linked immunosorbent assay for the assessment of associated changes in neurotransmitters —— Animals were euthanized after MRS study and brain samples were collected. Serotonin and dopamine levels were assessed in 10 mg of tissue extracts from brainstem and cortex, with ELISA kits. / Results: Study I: Bladder reduction surgery did not affect the increase in body weight post -operatively. Average body weight of the RBV and the sham groups were 340.2 ± 47.2 g and 340.5 ± 67.9 g respectively at 4 weeks post operatively. / Study II: Compared to sham group, the maximum cystometric capacity in animals with RBV was remarkably reduced at week 4 (0.78 ± 0.12 ml vs. 1.46 ± 0.22 ml, RBV vs. Sham respectively; p<0.005). Moreover, maximum detrusor pressure during voiding was significantly increased in RBV group at week 4 post operatively (32.4± 2.14 vs.23.27±1.2 5 cm H2O, RBV vs. Sham respectively). / Study III: Light non-repaid eye movement sleep occurred significantly more in RBV rats compared to sham group (61.8% vs 35%). Deep sleep and rapid eye movement sleep occurred significantly less in RBV group compared to that of sham group (30.7% vs 53.4%). / Study IV: Results showed that the RBV group used a significantly longer latency to locate the platform compared to Sham group (24.4s vs 17.19s, RBV vs. Sham respectively, p<0.001).. Moreover, significantly more animals from the RBV group could not complete the visit of the 8 arms of radial maze than that of the sham group. / Study V: Seven metabolites were detected and quantified. The results demonstrated significant changes in the lactate (Lac) metabolism in some specific regions of rat brain. At 4 weeks post - operatively, level of lactate significantly decreased in the hippocampus (43%, P<0.001) cingulate and retrosplenial cortex (29%, p<0.05) of RBV rats compared to that of sham rats. / Study VI: Results demonstrated a significant increase in Serotonin level in the brainstem of RBV rats compared to that of SHAM rats (23.726 + 0.88 ng/ml vs. 1.88 + 0.302 ng/ml). Dopamine levels decreased significantly in brainstem samples of RBV group compared to sham group (2.85 + 0.10 ng/ml vs. 6.85 + 0.84 ng/ml). / Conclusion: Surgical bladder volume reduction of bladder capacity can induce functional changes in the central nervous system. An alteration of the sleep architecture occurred in response to surgical reduction of bladder volume in rats, suggesting that there exists a potential for central consequences of bladder dysfunction. Bladder disorder chronically altered brain energy metabolism. Furthermore, bladder disorder altered the central neurotransmission in the brainstem and cortex. The finding of bladder dysfunction induced significant impairments in cognitive function in RBV rats, suggesting that the alteration in brain energy metabolism may contribute to the behavioral and attention problems, impaired learning and cognitive performance. / 研究背景： 原發性夜間遺尿症（PNE）是一種異質性疾病，涉及多種潛在的病理生理機制。我們最近的研究主要集中在膀胱功能，睡眠和腦功能的關係，結果顯示膀胱和腦功能障礙同時出現在患有嚴重難治性的PNE的兒童。因此，我們建議採用一種已改變膀胱功能的動物模型來評估膀胱功能異常會否引起腦幹排尿中心和/或睡眠 - 覺醒中心的功能紊亂 / 研究工具和方法： 研究被分成6個部分。雄性Wistar大鼠（約1.5個月）被用於研究。 / 研究I： 動物模型的建立 —— 雄性Wistar大鼠（200-220克），會先接受假手術或手術降低膀胱容量（RBV）。手術後4至5週，動物會進行進一步的膀胱測壓，腦電圖，MRS和認知功能研究。 / 研究II： 以常規填充膀胱測壓（CFC）評估減少膀胱容量手術對膀胱功能的變化 —— 二十四隻大鼠（RBV=12，對照=12）被用於研究。 CFC是用以評估在有意識的條件下，膀胱因膀胱容量減少的手術而引起的功能變化。 / 研究III： Radiotelemetered腦電圖研究，以評估在大鼠膀胱功能失調對睡眠結構和皮質覺醒的影響 —— 二十四隻大鼠（RBV=12，對照=12）被用於研究。膀胱容量減少的手術4週後，Radiotelemeters被植入在兩個組別的大鼠，並監測其腦電生物電勢和膀胱內壓48小時，然後手動評估睡眠結構和皮層覺醒。。 / 研究IV： 評估在膀胱容量減少的手術後對認知功能的影響 —— 103個大鼠（RBV=56，對照= =47）被用於研究。 / Morris水迷宮任務： 一個圓形的塑料半透明池盛載半滿的水，溫度介乎26 - ±2℃，手術4週後，該池被用在莫里斯動物進行連續9次Morris水迷宮（MWM）培訓（每天2次）。 / 八臂迷宮： 食物顆粒被隨機放置在迷宮的每個臂內，大鼠可以自由地探索迷宮5分鐘。大鼠被允許探索迷宮5分鐘。在每個手臂所用的總時間，以及在迷宮行走的總距離都會被記錄。 / 研究V： 以磁共振波譜檢測膀胱容量減少的手術所引起的膀胱功能障礙對腦功能的改變 —— 以質子磁共振波譜研究24隻大鼠腦內的代謝變化(RBV=12，對照==12）。以7 T MRI掃描儀進行磁共振波譜實驗，然後使用jMRUI軟件處理MR譜。 / 第六期： 以酶聯免疫吸附測定法評估神經遞質的相關變化 —— 動物在進行MRS研究後實施安樂死，並收集其腦樣品。從腦幹和皮層提取10毫克組織提取物，使用ELISA試劑盒，以評估羥色胺和多巴胺水平。 / 結果： 研究I： 膀胱容量減少手術並沒有影響體重增加。手術4週後，利巴韋林和對照實驗組的平均體重分別為340.2±47.2克和340.5±67.9克。 / 研究II： 相比起對照實驗組的動物，RBV組的最大膀胱容量顯著降低（0. 0.78 ± 0.12毫升對1.46±0.22毫升），排尿頻率顯著增加（2.53±0.30 對.0.53±0.05/hr）。此外，排尿時最大逼尿肌壓力亦顯著升高（32.0.8±2.19 比.20.37±1.2 5厘米水分子） / 研究III： 相比起對照實驗組的動物，光非快速動眼期睡眠顯著地較多發生於RBV大鼠身上（61.8％對35.6％），深層睡眠和快速動眼期睡眠顯著地較少發生在RBV組（32.3％對52.8％） / 研究IV： 結果表明，RBV組使用了顯著較長的時間來定位平台（24.4s vs. vs.17.19s）。而且，在RBV組，顯著地較多動物無法完成行走8臂的放射狀迷宮。 / 研究V： 進行檢測和定量七種代謝物。結果顯示乳酸（LAC）代謝在大鼠大腦的某些特定區域出現顯著變化。在手術4週後，相比起對照實驗組的動物，RBV組大鼠在海馬體（43％，P <0.001），扣帶和夾肌皮質（29％，P <0.05）的乳酸水平均顯著減少。 / 研究VI： 結果顯示RBV大鼠腦幹的血清素水平較對照實驗組的顯著增加（23.726+0.88納克/毫升與1.88±0.302ng/ml）。RBV大鼠腦幹的多巴胺水平則較對照實驗組的顯著下降（2.850.10納克/毫升與6.85+0.84毫微克/毫升）。 / 結論： 外科膀胱容量減少可誘導中樞神經系統的功能變化。以外科手術減少膀胱容量的大鼠亦引起睡眠結構改變，這顯示膀胱功能障礙對中樞有潛在影響。膀胱疾病長期改變大腦的能量代謝。此外，膀胱疾病亦改變了在腦幹和大腦皮層的中樞神經遞質傳遞。研究發現膀胱功能障礙顯著地損害RBV大鼠的認知功能，顯示改變大腦的能量代謝亦可導致行為和專注力的問題，從而損害學習和認知能力。 / Yeung, Chung Kwong. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 199-230). / Abstracts also in Chinese. / Title from PDF title page (viewed on 14, September, 2016). / Yeung, Chung Kwong. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Η υπερδραστηριότητα του εξωστήρα μυ της κύστης, που αποτελεί το αντικείμενο της παρούσας μελέτης, είναι μια ουροδυναμική παρατήρηση. Κατά κανόνα, η εργαστηριακή αυτή παρατήρηση συνοδεύει ένα κλινικό σύνδρομο, που χαρακτηρίζεται από συνδυασμό συμπτωμάτων από το κατώτερο ουροποιητικό σύστημα, και ονομάζεται σύνδρομο της υπερδραστήριας κύστης ή σύνδρομο έπειξης ή σύνδρομο συχνουρίας-έπειξης. Αν και το κλινικό σύνδρομο είναι εξαιρετικά συχνό και αποτελεί αναπόσπαστο τμήμα του καθημερινού όγκου δουλειάς κάθε ουρολόγου ή και γενικού ιατρού, η χρήση της σχετικής ονοματολογίας για τα συμπτώματα, τα σημεία και εργαστηριακά ευρήματα είναι πολλές φορές καταχρηστική και, ως εκ τούτου, η προκαλούμενη σύγχυση αναπόφευκτη. Η αιτιολογία της υπερδραστηριότητας του εξωστήρα, με εξαίρεση τις περιπτώσεις όπου ανιχνεύσιμη νευρολογική βλάβη μπορεί να ενοχοποιηθεί αιτιολογικά (νευροπαθής υπερδραστηριότητα εξωστήρα) είναι άγνωστη (ιδιοπαθής) παρά τις σχετικές θεωρίες που έχουν διατυπωθεί για την ερμηνεία της. Όσον αφορά την αντιμετώπιση της σχετικής συμπτωματολογίας υπάρχει πληθώρα μεθόδων τόσο συντηρητικών όσο και επεμβατικών. Η ποικιλία των διαθέσιμων φαρμακευτικών σκευασμάτων και διαφόρων επεμβατικών τεχνικών, αν όχι ανεξάντλητη είναι σίγουρα μεγάλη και αποδεικνύει την έλλειψη ιδανικής θεραπευτικής προσέγγισης. Η εκτίμηση του αποτελέσματος της όποιας θεραπευτικής παρέμβασης γίνεται άλλοτε με αντικειμενικά και άλλοτε με υποκειμενικά κριτήρια. Αδιαμφισβήτητα η υποκειμενική εκτίμηση του αποτελέσματος είναι ιδιαίτερα μεγάλης σημασίας, καθώς, δικαιωματικά, ο ίδιος ο ασθενής αποτελεί τον τελικό αποδέκτη των ενεργειών και παρενεργειών της θεραπείας. Όμως, η επιστημονική μέθοδος, απαραίτητη για την βελτίωση της κατανόησης της αιτιολογίας , της παθοφυσιολογίας της φυσικής ιστορίας και της θεραπευτικής προσέγγισης οποιασδήποτε παθολογίας, απαιτεί αυστηρά αντικειμενικά κριτήρια . Γίνεται κιόλας φανερό ότι υπάρχουν αρκετά κενά όσον αφορά την ονοματολογία, την αιτιολογία και τη διάγνωση της υπερδραστηριότητας του εξωστήρα. Όμως και στον τομέα της θεραπείας ή έλλειψη τόσο προγνωστικών κριτηρίων για την ανταπόκριση στη θεραπεία όσο και γενικά αποδεκτών, κλινικά σημαντικών, παραμέτρων εκτίμησης του αποτελέσματος επιβάλλουν την περαιτέρω μελέτη για την ανεύρεσή τους. Σ’ αυτή την κατεύθυνση επικεντρώνεται και προσπάθεια της συγκεκριμένης μελέτης. / -

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Die Dysregulation von Neurotransmittersystemen spielt eine wesentliche Rolle für die Pathophysiologie des Bladder Pain Syndrom/Interstitielle Zystitis (BPS/IC). Diese Arbeit beschäftigt sich daher mit der veränderten Expression muskarinerger (M2, M3) und purinerger (P2X1, P2X2, P2X3) Rezeptoren auf Urothelzellen und suburothelialen Myofibroblasten der Harnblasenwand im Rahmen BPS/IC. Dazu wurde eine Gruppe von Patientinnen mit Verdacht auf BPS/IC (n=17) einer Kontrollgruppe (n=7) gegenübergestellt. Die Gewebeproben der Patientengruppe sind im Zuge der Basisdiagnostik (transurethrales Harnblasenmapping) bei klinischem Verdacht auf das Vorliegen eines BPS/IC entnommen worden. Das Gewebe der Kontrollgruppe entstammt makroskopisch unauffälligen Bereichen von Harnblasen, welche im Rahmen einer radikalen Zystektomie oder einer lateral erweiterten endopelvinen Resektion (LEER-OP) entnommen worden sind. Die semi-quantitative Analyse der Rezeptorexpression erfolgte mittels indirekter Immunfluoreszenz, die Auswertung erfolgte mittels konfokaler Laserscanningmikroskopie. Die Ergebnisse der Patientengruppe wurden mit denen der Kontrollgruppe verglichen. Im Rahmen dessen wurde auch ein individuelles Rezeptorprofil für jeden Patienten erstellt. Es zeigte sich eine Hochregulation von M2R, M3R und P2X1R auf Urothelzellen sowie eine Hochregulation von M2R, M3R, P2X1R und P2X2R auf suburothelialen Myofibroblasten in der BPS/IC-Gruppe im Vergleich zur Kontrollgruppe. Des Weiteren zeigten sich individuelle Unterschiede in den Rezeptorprofilen der Patienten. Die Ergebnisse werden vor dem Hintergrund einer möglichen Beteiligung der Regulation von muskarinergen und purinergen Rezeptoren an der Pathophysiologie des BPS/IC diskutiert. Ferner werden diagnostische und therapeutische Möglichkeiten einer erweiterten Mollekulardiagnostik diskutiert.:Bibliografische Angaben 4 Abkürzungsverzeichnis 6 1. Einleitung 8 1.1. Das Bladder Pain Syndrom 8 1.1.1. Definition 8 1.1.2. Epidemiologie 10 1.1.3. Ätiologie und Pathophysiologie 10 1.1.4. Diagnostik 13 1.1.5. Therapie 16 1.2. Anatomische und physiologische Grundlagen 20 1.2.1. Das Urothel 21 1.2.2. Lamina propria 22 1.2.3. Muskarinerge Acetylcholinrezeptoren 23 1.2.4. Purinerge Rezeptoren 27 1.3. Fragestellung und Zielsetzung 31 2. Material und Methoden 32 2.1. Material 32 2.2. Methoden 33 2.2.1. Immunhistologie 33 2.2.2. Konfokale Laserscanning Mikroskopie und Auswertung 33 3. Ergebnisse 37 3.1. Lichtmikroskopie 37 3.2. Laserscanningmikroskopie 40 3.2.1. Rezeptorexpression im Urothel 40 3.2.2. Statistischer Vergleich von Kontroll-und BPS/IC-Gruppe im Urothel 42 3.2.4. Statistischer Vergleich von Kontroll-und BPS/IC-Gruppe auf sMF 46 3.2.5. Rezeptorprofile von Urothelzellen und sMF 47 3.3. Zusammenfassung 52 4. Diskussion 53 4.1. Diagnostisches Dilemma 53 4.2. Rezeptorverteilung im Urothel 61 4.3. Rezeptorverteilung auf sMF 64 4.4. Diagnostische und therapeutische Möglichkeiten des Rezeptorprofiling 65 4.5. Methodik der vorliegenden Arbeit 69 4.7. Zusammenfassung 71 Anhang 73 Referenzen 75 Erklärung über die eigenständige Abfassung der Arbeit 84

Die Dysregulation von Neurotransmittersystemen spielt eine wesentliche Rolle für die Pathophysiologie des Bladder Pain Syndrom/Interstitielle Zystitis (BPS/IC). Diese Arbeit beschäftigt sich daher mit der veränderten Expression muskarinerger (M2, M3) und purinerger (P2X1, P2X2, P2X3) Rezeptoren auf Urothelzellen und suburothelialen Myofibroblasten der Harnblasenwand im Rahmen BPS/IC. Dazu wurde eine Gruppe von Patientinnen mit Verdacht auf BPS/IC (n=17) einer Kontrollgruppe (n=7) gegenübergestellt. Die Gewebeproben der Patientengruppe sind im Zuge der Basisdiagnostik (transurethrales Harnblasenmapping) bei klinischem Verdacht auf das Vorliegen eines BPS/IC entnommen worden. Das Gewebe der Kontrollgruppe entstammt makroskopisch unauffälligen Bereichen von Harnblasen, welche im Rahmen einer radikalen Zystektomie oder einer lateral erweiterten endopelvinen Resektion (LEER-OP) entnommen worden sind. Die semi-quantitative Analyse der Rezeptorexpression erfolgte mittels indirekter Immunfluoreszenz, die Auswertung erfolgte mittels konfokaler Laserscanningmikroskopie. Die Ergebnisse der Patientengruppe wurden mit denen der Kontrollgruppe verglichen. Im Rahmen dessen wurde auch ein individuelles Rezeptorprofil für jeden Patienten erstellt. Es zeigte sich eine Hochregulation von M2R, M3R und P2X1R auf Urothelzellen sowie eine Hochregulation von M2R, M3R, P2X1R und P2X2R auf suburothelialen Myofibroblasten in der BPS/IC-Gruppe im Vergleich zur Kontrollgruppe. Des Weiteren zeigten sich individuelle Unterschiede in den Rezeptorprofilen der Patienten. Die Ergebnisse werden vor dem Hintergrund einer möglichen Beteiligung der Regulation von muskarinergen und purinergen Rezeptoren an der Pathophysiologie des BPS/IC diskutiert. Ferner werden diagnostische und therapeutische Möglichkeiten einer erweiterten Mollekulardiagnostik diskutiert.:Bibliografische Angaben 4 Abkürzungsverzeichnis 6 1. Einleitung 8 1.1. Das Bladder Pain Syndrom 8 1.1.1. Definition 8 1.1.2. Epidemiologie 10 1.1.3. Ätiologie und Pathophysiologie 10 1.1.4. Diagnostik 13 1.1.5. Therapie 16 1.2. Anatomische und physiologische Grundlagen 20 1.2.1. Das Urothel 21 1.2.2. Lamina propria 22 1.2.3. Muskarinerge Acetylcholinrezeptoren 23 1.2.4. Purinerge Rezeptoren 27 1.3. Fragestellung und Zielsetzung 31 2. Material und Methoden 32 2.1. Material 32 2.2. Methoden 33 2.2.1. Immunhistologie 33 2.2.2. Konfokale Laserscanning Mikroskopie und Auswertung 33 3. Ergebnisse 37 3.1. Lichtmikroskopie 37 3.2. Laserscanningmikroskopie 40 3.2.1. Rezeptorexpression im Urothel 40 3.2.2. Statistischer Vergleich von Kontroll-und BPS/IC-Gruppe im Urothel 42 3.2.4. Statistischer Vergleich von Kontroll-und BPS/IC-Gruppe auf sMF 46 3.2.5. Rezeptorprofile von Urothelzellen und sMF 47 3.3. Zusammenfassung 52 4. Diskussion 53 4.1. Diagnostisches Dilemma 53 4.2. Rezeptorverteilung im Urothel 61 4.3. Rezeptorverteilung auf sMF 64 4.4. Diagnostische und therapeutische Möglichkeiten des Rezeptorprofiling 65 4.5. Methodik der vorliegenden Arbeit 69 4.7. Zusammenfassung 71 Anhang 73 Referenzen 75 Erklärung über die eigenständige Abfassung der Arbeit 84 Lebenslauf: 85 Danksagung: 86

Les tumeurs de la vessie sont le quatrième cancer en terme de fréquence chez l’homme dans les pays industrialisés. Elles peuvent schématiquement être séparées en deux sous-groupes principaux : les tumeurs basales, peu différenciées, et les tumeurs luminales, différenciées. PPARγ est un récepteur nucléaire fortement exprimé dans ce second groupe, qui agit en hétérodimère avec un co-récepteur partenaire, RXRα, et possède un rôle essentiel dans la différenciation des cellules de l’urothélium normal. Récemment, un rôle protumorigénique de PPARγ a été mis en évidence dans les tumeurs luminales de vessie, où son activité est augmentée par le biais d’amplifications de PPARγ, ainsi que des mutations activatrices de son partenaire, RXRα. Le premier axe de mon projet a consisté à mieux caractériser ce rôle protumorigénique de PPARγ. J’ai d’abord participé à la mise en évidence de mutations récurrentes activatrices de PPARγ dans les tumeurs luminales de la vessie renforçant le rôle protumorigénique du récepteur dans ces tumeurs. J’ai ensuite cherché à identifier les gènes cibles de l’hétérodimère PPARγ/RXRα pouvant médier cet effet protumorigénique. Grâce à des analyses transcriptomiques après extinction de l’expression PPARγ ou de RXRα et des expériences de ChIP-sequencing de PPARγ et RXRα, j’ai pu identifier 30 gènes candidats. L’étude de l’implication de ces gènes dans la progression tumorale des tumeurs luminales présentant des altérations de la voie PPARγ/RXRα est actuellement en cours. Parallèlement à ce rôle protumorigénique dans les tumeurs luminales, des résultats suggéraient que ce gène pourrait posséder un rôle suppresseur de tumeurs dans le sous-groupe basal. La deuxième partie de mon projet a consisté à explorer cette hypothèse. J’ai pu montrer que des délétions hétérozygotes de PPARγ sont associées à ce sous-groupe de tumeurs basales, qui présente également une diminution globale de l’expression de PPARγ. De plus, parmi les mutations non-récurrentes de PPARγ identifiées dans ces tumeurs, certaines sont des mutations inactivatrices, capables d’inhiber l’activité transcriptomique de l’hétérodimère PPARγ/RXRα en favorisant la fixation de co-répresseurs de l’hétérodimère. J’ai également pu montrer un rôle anti-tumoral de PPARG dans les tumeurs basales puisque l’expression de PPARγ dans des lignées cellulaires basales à la suite de leur transfection avec un plasmide codant pour PPARγ est capable d’inhiber leur viabilité. Ce projet a ainsi permis de mettre en évidence un rôle dual de PPARγ dans les tumeurs de vessie, avec un rôle protumorigénique dans les tumeurs luminales, où il est suractivé par des amplifications et des mutations activatrices, et un rôle suppresseur de tumeurs dans les tumeurs basales, où il est réprimé par des délétions et de mutations inactivatrices. / Bladder tumors are the fourth cancer in terms of frequency in men, in industrialized countries. Bladder cancers can be divided into two main subgroups: undifferentiated basal tumors and differentiated luminal tumors. The nuclear receptor PPARγ, which is highly expressed in the second subgroup, forms a heterodimer with its partner, the nuclear receptor RXRα, and plays a key role in normal urothelial differentiation. A protumorigenic role of PPARγ has been established in luminal bladder cancer, with an increased activity through PPARγ genomic amplification or activating mutations of its partner, RXRα. The first part of my project aimed to better characterize this protumorigenic effect. I first participated in the identification of recurrent activating mutations of PPARγ in the luminal subgroup, enhancing its protumorigenic role in those tumors. Then, I tried to identify the PPARγ/RXRα heterodimer target genes that drive its protumorigenic role. By analyzing transcriptomic data following down regulation of PPARγ and RXRα, as well as ChIP-sequencing data for each of them, I identified 30 candidate target genes. The implication of the candidate genes in tumor progression of luminal cancer carrying PPARγ/RXRα pathway alteration is in progress. As opposed to its protumorigenic role in luminal tumors, some results suggested that PPARγ could play a tumor suppressor role in the basal subgroup. The second part of my project explored this hypothesis. I characterized PPARγ deletions associated with the basal subgroup, which presents a global PPARγ downregulation. Moreover, some of the non-recurrent mutations identified in this subgroup are inactivating mutations, able to inhibit the transcriptomic activity of the PPARγ/RXRα heterodimer, by an enhanced affinity of the heterodimer for co-repressors. I also showed an antitumor effect of PPARγ in basal tumors: its expression in basal bladder cell lines after transfection with a plasmid coding for PPARγ was able to inhibit cell viability. This project highlighted the dual role of PPARγ in bladder tumors, with a protumorigenic effect in luminal tumors through amplifications and activating mutations, and a tumor suppressor effect in basal tumors through deletions and inactivating mutations.

Bladder Cancer is the tenth most common malignancy globally, and is the thirteenth most common cause of tumor associate morbidity. Bladder cancer is largely stratified into two categories: Non-Muscle Invasive Bladder Cancer (NMIBC) and Muscle Invasive Bladder Cancer (MIBC). NMIBC represents disease localized to the urinary bladder, and can be stratified into low and high-grade disease. MIBC represents an aggressive class of bladder cancer, with invasion into the underlying muscle layers of the bladder. MIBC can be classified as either non-metastatic MIBC, with disease localized to the bladder corpus, or metastatic MIBC, with disease spreading to sites beyond the bladder corpus. High grade NMIBC presents significant risk for progression to MIBC, and collectively both high grade NMIBC and MIBC bladder cancers demonstrate poor prognostic outcomes in clinical settings in terms of responses to therapy, recurrence risks, and overall survival. Hexaminolevulinate is a precursor of Protoporphyrin IX (PpIX) in the heme biosynthetic pathway. Hexaminolevulinate has been FDA approved under the trade name Cysview for diagnostic usage in blue light cystoscopies for fluorescence mediated visualization of disease along the bladder wall. I demonstrate that in addition to its diagnostic utility, Cysview and blue light irradiation can be utilized clinical as a potential therapeutic modality. I demonstrate the significant selective cytotoxicity of Cysview in combination with blue light against patient derived organoids (PDOs) from primary bladder cancers. My results determine that Cysview and blue light induce a rapid cell death program mediated by an influx in Reactive Oxygen Species (ROS) production, resulting in less than 5% viability within 24 hrs of treatment. This massive loss in viability is observed in low and high grade NMIBC, as well as MIBC derived PDOs with diverse mutational profiles. The results of this work demonstrate that PDOs are a significant platform for assessing therapy responses for correlation with the large patient population. Furthermore, the work identifies photodynamic therapy with Cysview and blue light irradiation as a putative therapeutic modality for localized bladder cancers, with the potential for significant improvement in patient outcomes. The identification and characterization of the therapeutic effects of Cysview come at a critical time during a global shortage of conventional therapeutics for localized bladder cancer, and presents a pathway for patients affected by these shortages. Progression in bladder cancer has been understood to be driven by processes governing subpopulation and cell state and lineage transformation. Previous studies identify phenotypic plasticity within a subset of bladder cancers and have correlated this phenomenon with an increased risk for disease progression from NMIBC to MIBC. In previous work, a subset of PDOs derived from luminal primary tumors demonstrated significant degrees of luminal to basal plasticity in vitro. In my analysis of these PDOs using transcriptomic and chromatin accessibility data, I identified a transcriptomic and epigenetic signature unique to plastic PDOs. Furthermore, I identified HNF1B, GRHL2, GATA6, and SNAI2 as putative regulators of luminal to basal plasticity in bladder cancer. Using these molecular profiles, I correlated the plasticity phenotype with reduction in overall survival using data from published bladder cancer patient cohorts. Finally, I developed a novel transcriptomic subtypes classification scheme and an accompanying R package to classify epithelial heterogeneity in bladder cancer, based on the transcriptomic subtypes I identified in bladder cancer PDOs.