Brain-derived neurotrophic factor in urinary continence and incontinence

Nat Rev Urol. 2014 Oct;11(10):579-88. doi: 10.1038/nrurol.2014.244. Epub 2014 Sep 16.

Abstract

Urinary incontinence adversely affects quality of life and results in an increased financial burden for the elderly. Accumulating evidence suggests a connection between neurotrophins, such as brain-derived neurotrophic factor (BDNF), and lower urinary tract function, particularly with regard to normal physiological function and the pathophysiological mechanisms of stress urinary incontinence (SUI) and bladder pain syndrome/interstitial cystitis (BPS/IC). The interaction between BDNF and glutamate receptors affects both bladder and external urethral sphincter function during micturition. Clinical findings indicate reduced BDNF levels in antepartum and postpartum women, potentially correlating with postpartum SUI. Experiments with animal models demonstrate that BDNF is decreased after simulated childbirth injury, thereby impeding the recovery of injured nerves and the restoration of continence. Treatment with exogenous BDNF facilitates neural recovery and the restoration of continence. Serotonin and noradrenaline reuptake inhibitors, used to treat both depression and SUI, result in enhanced BDNF levels. Understanding the neurophysiological roles of BDNF in maintaining normal urinary function and in the pathogenesis of SUI and BPS/IC could lead to future therapies based on these mechanisms.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Animals
  • Antidepressive Agents / pharmacology
  • Antidepressive Agents / therapeutic use
  • Brain-Derived Neurotrophic Factor / drug effects
  • Brain-Derived Neurotrophic Factor / metabolism*
  • Brain-Derived Neurotrophic Factor / physiology
  • Cystitis, Interstitial / metabolism
  • Female
  • Humans
  • Quality of Life
  • Receptors, Glutamate / metabolism
  • Urethra / metabolism*
  • Urethra / physiology
  • Urethra / physiopathology
  • Urinary Bladder / metabolism*
  • Urinary Bladder / physiology
  • Urinary Bladder / physiopathology
  • Urinary Incontinence / metabolism
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence, Stress / drug therapy
  • Urinary Incontinence, Stress / metabolism*
  • Urinary Incontinence, Stress / physiopathology
  • Urinary Tract / metabolism
  • Urinary Tract / physiopathology
  • Urination / physiology

Substances

  • Antidepressive Agents
  • Brain-Derived Neurotrophic Factor
  • Receptors, Glutamate