Relation between Cajal Cell Density and Radiological and Scintigraphic Outcomes in Patients with Ureteropelvic Junction Obstruction

<b><i>Introduction:</i></b> In this study, we aimed to investigate the correlation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters in ureteropelvic junction obstruction (UPJO). <b><i>Methods:</i></b> The study group consisted of 41 renal units (38 consecutive patients; 13 female and 25 male) surgically treated for UPJO. UPJ specimens from patients were immuno-stained with CD117 (c-kit) antibody for interstitial Cajal cells (ICCs). The relation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters was evaluated. <b><i>Results:</i></b> The mean age of the patients was 8.52 ± 8.86 (0–35) years. The density of Cajal cells was defined in 2 groups for convenient analysis as 0–5 cells (low) in 19 (46.3%) patients and &#x3e;5 cells (moderate-high) in 22 (53.6%). There was significant difference between the preoperative and postoperative anteroposterior diameters of the related kidneys in both Cajal groups (<i>p</i> = 0.001-low, <i>p</i> = 0.000-moderate-high) independent of Cajal cell density. Regression in hydronephrosis postoperatively was determined in both Cajal groups (77.8%-low, 64.7%-moderate-high); however, there was no difference between them (<i>p</i> = 0.39). Preoperative T1/2 was significantly longer in the low Cajal group (<i>p</i> = 0.02). Postoperative T1/2 decreased in both low (<i>p</i> = 0.000) and moderate-high (<i>p</i> = 0.001) Cajal groups, but no difference was found between them (<i>p</i> = 0.24). There was significant improvement in the kidney differential function after surgery in the low Cajal density group (<i>p</i> = 0.015) while there was no correlation between the scintigraphic success or improvement and Cajal cell density (<i>p</i> = 0.51). <b><i>Discussion/Conclusion:</i></b> ICC deficiency/density could not be shown as a predictive factor for the determination of success rate of pyeloplasty. Despite the lack of any evidence for the degree of deficiency as an indicator for the severity of obstruction and prediction of surgical success, further studies are needed for confirmation.

Cajal cells and post-surgical dismotility in Hirschsprung disease

Hirschsprung disease (HD) is characterised by the absence of ganglion cells in myenteric and submucosal plexus in the distal colon in its classical form. As a consequence intestinal motility dysfunction occurs, the clinical picture resembles structural obstruction. Diagnosis of aganglionosis is performed by rectal biopsy and treatment is surgical by removing the aganglionosis portion. Intersticial Cajal cells modulate the motor function of smooth muscle cells by the synaptic connection with the enteric nervous system. The identification of the numeric decrease of these cells in the ganglionic intestinal portion in the HD allowed elaborating the hypothesis that numeric reduction of Cajal cells may cause symptoms of post-surgical intestinal dysmotility.The present study tryed to verify this hypothesis, by identifying an association between post-surgical complications and number of Cajal cells in the ganglionic segment.Medical records and histological samples of patients in post-surgical HD status and followed at Unicamp Clinics Hospital, operated from 2001 to 2014, were re-examined. Immunohistochemistry for Cajal cells were performed in order to count cells number and were compared to historical values found in healthy adults.Although most of the cases present a number of low-ICC, the count of these ganglion cells segment is not associated with the occurrence of postoperative symptoms. The findings of this survey are similar to other studies with similar methodology.

Morphological analysis of interstitial Cajal cells and mast cells in experimental hyperactivity bladder and stress incontinence under influence of pharmacocorrection

The existing data indicate the multifactorial mechanisms of development of the overactive bladder (OAB) symptom, but the issue of OAB pathogenesis remains unclear. In more recent times, the neurogenic theory of OAB genesis has being accompanied by the increasing attention to the study of morphological changes that occur in the smooth myocytes of the detrusor and their interaction with the extracellular matrix. Therefore, the objective of our study became the evaluation of distribution of interstitial Cajal cells (ICC) and basophilic granulocytes (BG) in the structural elements of the bladder wall under stress urinary incontinence and its overactivity before and after treatment with Mirabegron, Spasmex, Quercetin and combination thereof with testosterone and estradiol, using histochemical and immunohistochemical methods. The experimental models of OAB and stress urinary incontinence (SUI) presented the increase in the amount and functional activity of BG revealed by histological and immunohistochemical methods, as well as ICC at all terms of OAB monitoring, while the SUI presented with high concentration and functional activity of BG only after 14 days of the experiment. After 28 days, we observed a sharp decrease of the parameters, indicating decompensation and depletion of the functional activity. The number of ICC decreased under SUI after both 14 days and 28 days of the experiment. The group of experimental animals receiving Spasmex and its combination with hormones, presented no significant effect on the quantitative and qualitative composition of BG and ICC at OAB and SUI on Day 14 of the experiment, but the combination with testosterone demonstrated statistically reliable (p<0.001) reduction of BG and ICC expression in the muscle layer of the bladder after 14 days, and unreliable after 28 days of the experiment (p>0.05). The administration of Mirabegron alone and especially its combination with testosterone and estradiol presented positive trends in histochemical and immunohistochemical expression of BG and ICC. The experiment proved high efficacy of Quercetin in combination with testosterone and estradiol under OAB and SUI, confirmed by stabilization of the functional activity of BG and ICC quantitative composition.

The role of Cajal cells in chronic prostatitis

Types of prostatitis can be defined as groups of syndromes in adult men associated with infectious and noninfectious causes characterized frequently by lower abdominal and perineal signs and diverse clinical symptoms and complications. Etiopathogenesis of chronic prostatitis is not well defined. Moreover, its treatment outcomes are not satisfactory. Presence of c-kit positive interstitial cells in human prostate is already known. It has been demonstrated that these cells can be pacemaker cells which trigger spontaneous slow-wave electrical activity in the prostate and can be responsible for the transport of glandular secretion from acinar cells into major and minor prostatic ducts and finally into urethra. In the light of all these data, when presence of a possible inflammatory pathology is thought to involve prostate that secretes and has a reservoir which drains its secretion (for prostate, prostatic urethra), two points are worth mentioning. Impairment of secretion mechanism and collection of secretion within the organ with reflux of the microbial material from its reservoir back into prostate gland. Both of these potential conditions can be explained by ductal neuromuscular mechanism, which induces secretion. We think that in this neuromuscular mechanism interstitial Cajal cells have an important role in chronic prostatitis. Our hypothesis is that curability of prostatitis is correlated with the number of Cajal cells not subjected to apoptosis.