title: Modulation of urinary bladder innervation: TRPV1 and botulinum toxin A.
abstract: The persisting interest around neurotoxins such as vanilloids and botulinum toxin (BoNT) derives from their marked effect on detrusor overactivity refractory to conventional antimuscarinic treatments. In addition, both are administered by intravesical route. This offers three potential advantages. First, intravesical therapy is an easy way to provide high concentrations of pharmacological agents in the bladder tissue without causing unsuitable levels in other organs. Second, drugs effective on the bladder, but inappropriate for systemic administration, can be safely used as it is the case of vanilloids and BoNT. Third, the effects of one single treatment might be extremely longlasting, contributing to render these therapies highly attractive to patients despite the fact that the reasons to the prolonged effect are still incompletely understood. Attractive as it may be, intravesical pharmacological therapy should still be considered as a second-line treatment in patients refractory to conventional oral antimuscarinic therapy or who do not tolerate its systemic side effects. However, the increasing off-label use of these neurotoxins justifies a reappraisal of their pharmacological properties.
authors.affiliation: Institute of Histology and Embryology, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Charrua
authors.forename: António
authors.initials: A
authors.lastname: Avelino
authors.forename: Francisco
authors.initials: F
authors.lastname: Cruz
mesh_terms: D000283:Administration, Intravesical; D000818:Animals; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009498:Neurotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D050916:TRPV Cation Channels / Q000187:drug effects* / Q000378:metabolism; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000294:innervation / Q000378:metabolism; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D018727:Muscarinic Antagonists; D009498:Neurotoxins; D050916:TRPV Cation Channels; C494482:TRPV1 protein, human; D019274:Botulinum Toxins, Type A