RESUMEN
OBJECTIVES: To investigate clinical outcomes, bacterial virulence factors, and antimicrobial resistance in E. coli from young men presenting with acute bacterial prostatitis. METHODS: Initial E. coli isolates from previously healthy young men with no factors compromising urinary tract anatomy or function were tested for virulence-associated genes by polymerase chain reaction (PCR) assays, phylogenetic grouping by triplex polymerase PCR, and antibiotic resistance. RESULTS: All 18 patients responded to treatment, including 2 who required long-term therapy. E. coli were allocated to phylogenetic groups B2 (13 strains) and D (5 strains). Prostatitis isolates belonged to clones mainly represented by extraintestinal pathogenic E. coli (ExPEC) and preferentially uropathogenic E. coli and displayed marked accumulation of virulence genes (hly, cdt1, clb, pap, sfa/foc, fyuA, iroN, kpsMT(II), and traT) characteristic of highly virulent ExPEC. All phylogenetic group B2 strains coded for at least 1 toxin with carcinogenic potential (Colibactin, cytolethal distending toxins, or cytotoxic necrotizing factor). In contrast to their accumulation of virulence-associated traits, prostatitis strains were sensitive to standard antibiotics. CONCLUSIONS: The phylogenetic background and accumulation of an exceptional repertoire of extraintestinal pathogenic virulence-associated genes indicate that these E. coli strains belong to a highly virulent subset of uropathogenic variants. In contrast, antibiotic resistance was minimal in these E. coli strains from previously healthy, young outpatients.
Asunto(s)
Farmacorresistencia Microbiana , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Escherichia coli/metabolismo , Prostatitis/diagnóstico , Prostatitis/microbiología , Enfermedad Aguda , Adolescente , Adulto , Genotipo , Humanos , Masculino , Fenotipo , Resultado del Tratamiento , Sistema Urinario/microbiología , Virulencia , Factores de Virulencia/metabolismoRESUMEN
New genome sequence information was used to study evolution of 22 dinucleotide simple sequence repeat (diSSR) sites whose upstream flanking sequences were shown to be conserved comparing Homo sapiens with the marsupial, Monodelphis domestica. Among mammals, most of these diSSR sites were conserved both upstream and downstream of the diSSR. However, individual diSSRs were frequently replaced by alternative repeats. Conserved among mammals examined, the Vsnl1 gene's 3' UTR-localized (AC)n repeat replaced an A-rich tract in non-mammalian vertebrates examined. The Sema6D gene's (GT)n was also well conserved among mammals examined. Such conservation provides evidence of a functional role. The UTR-localized diSSRs of other genes evolved by replacing alternative diSSRs, by replacing mononucleotide-rich tracts and, in fewer cases, by expansion from short repeating sequences. Extension of the study to less conserved diSSR sites revealed that some diSSRs replaced post-transcriptional regulatory motifs, such as AU-rich elements (AREs) and C-rich tracts. The Mtap2 gene's UTR-localized (AC)n was located within a known dendritic targeting element. These evolutionary replacements suggest that some diSSRs belong to a broader group of weak-folding repetitive sequences with potential regulatory roles.
Asunto(s)
Regiones no Traducidas 3'/genética , Repeticiones de Dinucleótido/genética , Evolución Molecular , Repeticiones de Minisatélite/genética , Secuencias Reguladoras de Ácidos Nucleicos/genética , Proteínas Adaptadoras Transductoras de Señales/genética , Animales , Secuencia de Bases , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/genética , Secuencia de Consenso , Secuencia Conservada/genética , Proteínas del Citoesqueleto/genética , Factores de Transcripción Forkhead/genética , Variación Genética , Marsupiales/genética , Proteínas Asociadas a Microtúbulos/genética , Datos de Secuencia Molecular , Neuronas/metabolismo , Filogenia , Primates/genética , Roedores/genéticaRESUMEN
To study evolution of dinucleotide simple sequence repeats (diSSRs) we searched recently available mammalian genomes for UTR-localized diSSRs with conserved upstream flanking sequences (CFS). There were 252 reported Homo sapiens genes containing the repeats (AC)n, (GT)n, (AG)n or (CT)n in their UTRs including 22 (8.7%) with diSSR-upstream flanking sequences conserved comparing divergent mammalian lineages represented by Homo sapiens and the marsupial, Monodelphis domestica. Of these 22 genes, 19 had known functions including 18 (95%) that proved critical for mammalian nervous systems (Fishers exact test, P<0.0001). The remaining gene, Cd2ap, proved critical for development of kidney podocytes, cells that have multiple similarities to neurons. Gene functions included voltage and chloride channels, synapse-associated proteins, neurotransmitter receptors, axon and dendrite pathfinders, a NeuroD potentiator and other neuronal activities. Repeat length polymorphism was confirmed for 68% of CFS diSSRs even though these repeats were nestled among highly conserved sequences. This finding supports a hypothesis that SSR polymorphism has functional implications. A parallel study was performed on the self-complementary diSSRs (AT)n and (GC)n. When flanked by conserved sequences, the self-complementary diSSR (AT)n was also associated with genes expressed in the developing nervous system. Our findings implicate functional roles for diSSRs in nervous system development.
Asunto(s)
Secuencia Conservada/genética , ADN Intergénico/genética , Repeticiones de Dinucleótido/genética , Genes del Desarrollo , Repeticiones de Minisatélite/genética , Sistema Nervioso/embriología , Sistema Nervioso/metabolismo , Animales , Composición de Base/genética , Secuencia de Bases , Humanos , Ratones , Sistemas de Lectura Abierta/genética , Polimorfismo GenéticoRESUMEN
BACKGROUND: Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome, and asymptomatic inflammation. MATERIALS AND METHODS: We employed evidence-based methods to review the epidemiology of prostatitis syndromes. RESULTS: The prevalence of prostatitis symptoms could be compared in five studies surveying 10,617 men. Overall, 873 participants met various criteria for prostatitis, representing an overall rate of 8.2%, with prevalence ranging from 2.2 to 9.7%. A history of sexually transmitted diseases was associated with an increased risk for prostatitis symptoms. Men reporting a history of prostatitis symptoms had a substantially increased rate of benign prostatic hyperplasia, lower urinary tract symptoms and prostate cancer. In one study, the incidence of physician-diagnosed prostatitis was 4.9 cases per 1000 person-years. Two studies suggest that about one-third of men reporting prostatitis symptoms had resolution after 1 year. Patients with previous episodes and more severe symptoms are at higher risk for chronic pelvic pain. DISCUSSION: The prevalence of prostatitis symptoms is high, comparable to rates of ischaemic heart disease and diabetes. Clinical evaluation appears necessary to verify that prostatitis is responsible for patients' symptoms. Prostatitis symptoms may increase a man's risk for benign prostate hypertrophy, lower urinary tract symptoms and prostate cancer. We need to define natural history and consequences of prostatitis, develop better algorithms for diagnosis and treatment, and develop strategies for prevention.
Asunto(s)
Prostatitis/epidemiología , Prostatitis/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
We previously demonstrated that many "weak-folding" simple repeats were replaced during evolution by alternative weak-folding repeats. This suggested repeat selection at the level of higher order structure potential. Here, we demonstrate similar phenomena for "strong-folding" simple repeats in non-coding DNA. The Rabgap1 gene's 3' UTR contained the self-complementary repeat (AT)n in Homo sapiens but, in Mus musculus, this site was occupied by the complementary repeats (GT)n and (AC)n. Similarly, primate Plag1 UTRs contained various (GT)n-(AC)n palindromes but in rodents, this site was occupied by (AT)n, preserving folding potential more than primary sequence. The Znf516, Senp1, Rock2, and other UTRs exhibited similar replacements. In the Bnc2 UTR, (AT)n was replaced by sequences that evolved with approximate symmetry about a central axis, a pattern difficult to explain without invoking selection to preserve secondary structure. These observations reflect a predictable evolutionary pattern for some common non-coding genomic sequences.
Asunto(s)
ADN/química , Evolución Molecular , Conformación de Ácido Nucleico , Secuencias Repetitivas de Ácidos Nucleicos , Regiones no Traducidas/química , Animales , Secuencia de Bases , Bovinos , Secuencia Conservada , Perros , Humanos , Ratones , Datos de Secuencia Molecular , Conejos , RatasRESUMEN
OBJECTIVES: To determine the rate of gram-positive localizations and whether repetitive cultures demonstrate consistent localization of gram-positive bacteria in patients with chronic prostatitis symptoms. METHODS: We repeated localization cultures at different visits for untreated patients with chronic prostatitis symptoms. RESULTS: A total of 470 patients with chronic prostatitis had lower urinary tract localization cultures done. Ten-fold increases in the concentrations of gram-positive bacteria were noted when the postprostatic massage (VB3) or expressed prostatic secretions cultures were compared with first-void urine (VB1) cultures from 29 patients (6%). This was comparable to the 7% rate of gram-negative chronic bacterial prostatitis. We studied 49 patients who had undergone 130 repeated localization studies (median 2, range 2 to 4). Repeatedly negative studies were found in 20 patients, including 19 who each had undergone two studies and 1 who had undergone four studies. Of 9 patients who each had undergone three or four studies, 9 demonstrated localization of at least one gram-positive species. Of the 29 patients with gram-positive localizations, 27 (94%) did not have consistent localization of the gram-positive species. CONCLUSIONS: Patients with chronic prostatitis demonstrated localization of gram-positive bacteria, but the results were seldom reproducible in untreated patients. Gram-positive localizations may represent nonpathogens, transient bacterial colonization of the lower urinary tract, or intermittent shedding of prostatic pathogens. The limitations of traditional cultures highlight the need for better diagnostic approaches and improved recommendations for antimicrobial therapy.
Asunto(s)
Bacterias Grampositivas/aislamiento & purificación , Prostatitis/microbiología , Enfermedad Crónica , Humanos , MasculinoRESUMEN
Some untranslated sequence (UTR)-localized, short tandem repeats (STRs) exhibit evidence of selection pressure, including STR-coupling preferences, STR conservation, interspecies STR-STR replacements, and STR variants implicated in certain diseases. We wished to determine if STR replacements occurred near disease-related genes, including previously unstudied STRs as well as some STRs already implicated in disease. Among nine strong-candidate prostate cancer (CaP)-predisposing genes, three [steroid 5-alpha-reductase 2 (Srd5A-2), macrophage scavenger receptor-1 (MSR-1), and tumor necrosis factor receptor-21 (Tnfr-21)] exhibited striking STR replacements (P<0.001). The glomerular disease-related gene, CD2AP, exhibited an STR replacement flanked by well-conserved sequences, suggesting an STR-focused process. Another glomerular disease-related gene, rabphilin 3A, exhibited at least two STR replacements at the same UTR position comparing Drosophila melanogaster, Mus musculus, and Homo sapiens. Two genes implicated in blood-clotting disorders, von Willebrand factor (vWA) and fibrinogen alpha (FGA), exhibited multiple-intron STR replacements among mammals, extending STR replacement phenomena to introns. Among primates, a tyrosine hydroxylase (THO1) intron STR, previously implicated in both schizophrenia and drug withdrawal delirium, exhibited frequent replacements. Some STR replacements were early events in gene divergence. When STR sequences of closely related species were available, STR replacement was observed to be nearly as rapid as speciation. STR replacements expand the list of STR sequences that may contribute to genetic activity and to disease processes.
Asunto(s)
Expresión Génica/genética , Predisposición Genética a la Enfermedad/genética , Intrones/genética , Secuencias Repetidas en Tándem/genética , Regiones no Traducidas/genética , Animales , Secuencia de Bases , Perros , Humanos , Enfermedades Renales/genética , Masculino , Ratones , Modelos Genéticos , Datos de Secuencia Molecular , Conformación de Ácido Nucleico , Polimorfismo Genético , Enfermedades de la Próstata/genética , Neoplasias de la Próstata/genética , Ratas , Recombinación Genética , Especificidad de la EspecieRESUMEN
PURPOSE: Since few men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have culturable bacteria by traditional approaches, we used sensitive molecular methods to determine presence of fastidious microorganisms. MATERIALS AND METHODS: We evaluated 135 men with CP/CPPS by standardized clinical evaluation, and by lower tract localization cultures and chamber counts of expressed prostatic secretions of leukocytes. We excluded from study patients with bacteriuria, bacterial prostatitis, urethritis or positive urethral cultures. Prostate biopsy was obtained using a double-needle technique to limit contamination. We chose molecular approaches because previous studies had used culture antigen detection in urine, urethral swabs and expressed prostatic secretions. However, interpretation of such studies is complicated because urogenital samples often acquire bacteria while passing through the urethra. We used specific and broad-spectrum polymerase chain reaction (PCR) assays. RESULTS: Only 10 (8%) of the 135 subjects had positive specific PCR assays, including Mycoplasmia genitalium, Chlamydia trachomatis and Trichomonas vaginalis. Our findings suggested that C. trachomatis, T. vaginalis and M. genitalium may be identified in some patients with CP/CPPS, even among men with no evidence of urethritis and with negative urethral cultures and other assays. The broad-spectrum PCR assays provided the most provocative findings. DNA encoding tetracycline resistance was identified in 25% of subjects, and 77% of subjects had evidence of 16S rDNAs. The white blood cell concentration in the prostatic secretions correlated with identification of 16S rDNAs in prostate tissue (p <0.01). CONCLUSIONS: Delineating the precise role of these organisms in the etiology of CP/CPPS may help define better diagnostic and treatment algorithms.
Asunto(s)
Prostatitis/microbiología , Enfermedad Crónica , Genitales Masculinos/microbiología , Humanos , Masculino , Mycoplasma genitalium/aislamiento & purificación , Dolor Pélvico/microbiología , Reacción en Cadena de la Polimerasa , Próstata/microbiología , Próstata/patología , Prostatitis/clasificación , Prostatitis/cirugía , Síndrome , Uretritis/microbiología , Virginia , WashingtónRESUMEN
Our objective was to identify bacterial species present in culture-negative but 16S rDNA-positive amniotic fluid samples from women in preterm labor. Amniotic fluid from 69 women in preterm labor was cultured and examined for the proinflammatory cytokine interleukin-6 (IL-6). Polymerase chain reaction technology was used to detect highly conserved bacterial ribosomal DNA sequences (16S rDNAs). As previously reported, 16S rDNAs were identified in 15 (94%) of 16 culture-positive amniotic fluid samples, in 5 (36%) of 14 culture-negative samples with elevated IL-6, and in 1 (3%) of 39 culture-negative samples with low IL-6 levels. Direct sequencing was performed of 16S rDNAs from the 5 culture-negative amniotic fluid specimens with elevated IL-6, followed by database searches and phylogenetic analyses. The bacterial sequences identified included: two Leptotrichia sanguinegens, one human oral bacterium A33, one Fusobacterium nucleatum, and one Ureaplasma urealyticum. Identification and sequencing of 16S rDNAs in amniotic fluid is a promising technique to identify bacterial species associated with elevated IL-6 levels in culture-negative amniotic fluid that may contribute to the etiology of premature labor.
Asunto(s)
Líquido Amniótico/microbiología , ADN Bacteriano/análisis , ADN Ribosómico/análisis , Infecciones por Bacterias Gramnegativas/microbiología , Trabajo de Parto Prematuro/microbiología , ARN Ribosómico 16S/genética , Adulto , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Interleucina-6/análisis , Trabajo de Parto Prematuro/prevención & control , Reacción en Cadena de la Polimerasa , Embarazo , Factor de Necrosis Tumoral alfa/análisisRESUMEN
Within the genomes of multicellular organisms, short tandem repeating sequences (STRs) are ubiquitous, yet usage patterns remain obscure. The repeats (AC)n and (GU)n appear frequently in the untranslated regions (UTRs) of messenger RNAs (mRNAs). To investigate STR usage patterns, we used three approaches: (1) comparisons of individual mRNA database sequences including annotations and linked references, (2) statistical analysis of complete, UTR databases and (3) study of a large gene family, the aquaporins. Among 500 (AC)n- or (GU)n-containing mRNAs, 58 (12%) had known functions. Of these, 50 (86%) encoded proteins whose activities involved membranes or lipids, including integral membrane proteins, peripheral membrane proteins, ion channels, lipid enzymes, receptors and secreted proteins. A control sequence (AU)n also occurred in mRNAs, but only 5% encoded membrane-related functions. Investigation of all reported 3' UTR sequences, demonstrated that the STR (AC)n was 9 times more common in mRNAs encoding membrane functions than in the total UTR database (P < 0.001). Similarly, (GU)n was 8 times more common in membrane-function mRNAs than in the total database (P < 0.001). These observations suggest that (AC)n and (GU)n may be UTR signals for some mRNAs encoding membrane-targeted proteins.
Asunto(s)
Membrana Celular/metabolismo , ARN Mensajero/metabolismo , Secuencias Repetidas en Tándem , Regiones no Traducidas 3' , Regiones no Traducidas 5' , Animales , Acuaporinas/química , Secuencia de Bases , Bases de Datos como Asunto , Humanos , Metabolismo de los Lípidos , Ratones , Modelos Biológicos , Modelos Genéticos , Datos de Secuencia Molecular , Estructura Secundaria de Proteína , Ratas , Regiones no TraducidasRESUMEN
Simple repeats are ubiquitous in metazoan genomes, but function has been elusive. We reported that distinct, short tandem repeats (STRs) were coupled with rigorous polarity and register, suggesting order in simple repeat usage. Several STRs that lacked internal, canonical base pairs were associated with mRNAs encoding membrane functions and transcription factors. We hypothesized that diverse, simple repeats, such as (AC)n, (GU)n, (AG)n, (CU)n and (CUUU)n, had similar functions. The hypothesis predicts that closely related mRNAs would sometimes exhibit STR replacements. Comparing aquaporin 3 mRNAs, in rodents and humans, (GU)20 replaced (AG)29. Comparing biglycan mRNAs, (GU)25 replaced (CA)12. Comparing immunoglobulin superfamily member 9 mRNAs, the STR-couple, (CU)17(GU)9 replaced the STR-couple, (GU)19(GC)4. Comparing tumor necrosis factor receptor-21 mRNAs, (GU)24 replaced (CUUU)16. In a collection of 52 rodent-H. sapiens homologous mRNAs that had STRs, six (11.5%) STR-STR replacements occurred, significantly more than expected based on an STR frequency of 0.13% in all reported UTRs (p<0.001). Database studies and the observation of STR replacements among transcript homologs independently support the hypothesis that diverse repeat sequences, such as (AG)n, (AC)n, (GU)n, (CU)n and (CUUU)n, have similar usage that is consistent with analogous functions.
Asunto(s)
Repeticiones de Microsatélite/genética , ARN Mensajero/genética , Animales , Acuaporina 3 , Acuaporinas/genética , Secuencia de Bases , Biglicano , Repeticiones de Dinucleótido/genética , Proteínas de la Matriz Extracelular , Frecuencia de los Genes , Humanos , Inmunoglobulinas/genética , Proteínas del Tejido Nervioso/genética , Polimorfismo Genético , Proteoglicanos/genética , Ratas , Receptores del Factor de Necrosis Tumoral/genética , Homología de Secuencia de Ácido Nucleico , Especificidad de la Especie , Repeticiones de Trinucleótidos/genéticaRESUMEN
OBJECTIVES: The evaluation of WBCs in EPS is recommended for classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) but no agreement has been reached on the optimal method. We sought to determine the relationship between the expressed prostatic secretions (EPS) leukocyte (WBC) count per high-power field (evaluated by a more quantitative wet mount method and the traditional gram-stained smear method used in clinical microbiology laboratories) and the EPS WBC concentration to determine whether quantitative methods are necessary for accurate patient classification. METHODS: EPS collected from 94 patients with CP/CPPS were evaluated by gram-stained smear, a standardized wet mount, and a hemocytometer method. RESULTS: The gram-stained smear detected EPS WBCs in 21 (22%) of 94 subjects compared with 78 (83%) by the standardized wet mount and 57 (60%) by the hemocytometer method. The gram-stained EPS WBC count correlated poorly with the WBC concentration by hemocytometer (R(2) = 0.051, P = 0.03). Although the standardized EPS WBC count correlated better with the concentration by hemocytometer, the correlation coefficient remained low (R(2) = 0.244, P <0.0001). CONCLUSIONS: The standardized wet mount proved superior to the gram-stained smear, but both methods lacked precision. Quantitative determination of the EPS WBC concentration by a counting chamber method proved to be the superior evaluation for research studies of CP/CPPS.
Asunto(s)
Líquidos Corporales/citología , Recuento de Leucocitos , Dolor Pélvico/patología , Próstata/metabolismo , Prostatitis/patología , Enfermedad Crónica , Colorantes , Violeta de Genciana , Humanos , Recuento de Leucocitos/instrumentación , Recuento de Leucocitos/métodos , Masculino , Fenazinas , Reproducibilidad de los Resultados , Coloración y EtiquetadoRESUMEN
Short tandem repeats (STRs) have been widely observed, but most STRs have no recognized organization or function. Here we show that for diverse mRNAs, 84% of (GC)(n) repeats were found unexpectedly coupled with another STR, (GU)(n). These STR couples exhibited preferred polarity and register. In 3(') untranslated mRNA sequences (UTRs) 100% of (GC)(n>6) repeats were tightly coupled with (GU)(n). For (GC)(n), stem folding energy correlated with the length and number of neighboring, non-folding (GU)(n) partners (p=0.014). Approximately 20% of (AU)(n>/=14) repeats were coupled with (GU)(n). The STR couple (AC)(n)(AG)(n) also exhibited polarity and register preferences. The sequence arrangement at STR-couple joints was conserved rigorously, suggesting that these sequences were under selection pressure. Some STR couples may function as mRNA processing landmarks, based on alternative transcript comparisons. These observations suggest that some transcribed STRs may be functional UTR signals with predictable organization and usage patterns.
Asunto(s)
Regiones no Traducidas 3'/química , Secuencias Repetidas en Tándem , Animales , Secuencia de Bases , Secuencia Conservada , Secuencia Rica en GC , Variación Genética , Humanos , Ratones , Datos de Secuencia Molecular , Conformación de Ácido Nucleico , Ratas , Secuencias Repetidas en Tándem/fisiología , Transcripción GenéticaRESUMEN
To investigate the potential association between prostate infection and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), we used molecular approaches described in previous reports. These methods employed standard polymerase chain (PCR) reaction assays to provide a qualitative evaluation of prostatic bacterial species. Here, we report on the detection of prostatic bacteria using a real-time PCR. Template DNAs were examined from prostatic tissue samples from patients with CP/CPPS. Two PCR primer sets were used: one that amplifies a portion of all known bacterial ribosomal DNAs (16S rDNAs) and one that is specific for Escherichia coli as opposed to related, E. coli-like bacteria. The 16S rDNA real-time PCR assay detected bacterial DNAs in eight (26%) of 31 samples from patients with CP/CPPS, including three samples (10%) that were also positive by the E. coli real-time PCR assay. These E. coli positives were quantified at approximately 10(3) cfu/ml of tissue digested. Quantification, speed and specificity make real-time PCR a promising approach for the quantitative detection and identification of prostatic bacteria from CP/CPPS patients.
Asunto(s)
ADN Bacteriano/genética , Escherichia coli/genética , Dolor Pélvico/microbiología , Reacción en Cadena de la Polimerasa/métodos , Próstata/microbiología , Prostatitis/microbiología , Biopsia , Enfermedad Crónica , ADN Bacteriano/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Humanos , Masculino , Dolor Pélvico/complicaciones , Próstata/patología , Prostatitis/complicacionesRESUMEN
We review new data on the epidemiology of chronic prostatitis. These population-based studies used reasonable case-definitions to survey various populations from North America, Europe and Asia. Overall, 2-10% of adult men suffer from symptoms compatible with chronic prostatitis at any time and approximately 15% of men suffer from symptoms of prostatitis at some point in their lives. Other epidemiologic data suggest that chronic prostatitis may be associated with an increased risk for development of benign prostatic hyperplasia and prostate cancer. These data suggest that chronic prostatitis is an important international health care problem that merits increased priority from clinicians and researchers.
Asunto(s)
Hiperplasia Prostática/epidemiología , Neoplasias de la Próstata/epidemiología , Prostatitis/epidemiología , Adulto , Anciano , Asia , Enfermedad Crónica , Europa (Continente) , Humanos , Masculino , Persona de Mediana Edad , América del Norte , Hiperplasia Prostática/etiología , Neoplasias de la Próstata/etiología , Prostatitis/complicaciones , Factores de RiesgoRESUMEN
OBJECTIVES: To evaluate the possibility that patients with inflammatory and noninflammatory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) might present with different symptoms. Patients with CP/CPPS present with characteristic symptoms without bacteriuria. The new National Institutes of Health consensus suggests that CP/CPPS can be divided into inflammatory and noninflammatory categories. METHODS: Standardized symptom surveys were completed by 130 subjects who met the criteria for CP/CPPS after clinical examination and urethral, urine, expressed prostatic secretion (EPS), and seminal fluid analysis evaluations. RESULTS: When classified by either EPS or postprostatic massage urine (VB3) findings, subjects with and without inflammation had similar symptoms. However, when classified using the combination of EPS, VB3, and seminal fluid analysis, subjects with inflammatory CP/CPPS had more severe (P <0.02) and more frequent symptoms, in particular, difficulty reaching erection (P <0.01), weak urinary stream (P <0.01), urinary frequency (P = 0.03), and penile pain (P = 0.04). CONCLUSIONS: The increased severity and frequency of symptoms among patients with inflammatory CP/CPPS provide empirical support for the new consensus classification on the basis of the combination of EPS, VB3, and seminal fluid analysis findings.
Asunto(s)
Dolor Pélvico/clasificación , Prostatitis/clasificación , Análisis de Varianza , Enfermedad Crónica , Indicadores de Salud , Humanos , Recuento de Leucocitos , Masculino , Dolor Pélvico/complicaciones , Dolor Pélvico/orina , Próstata/metabolismo , Prostatitis/complicaciones , Prostatitis/orina , Semen , Índice de Severidad de la Enfermedad , SíndromeRESUMEN
Previously thought "junk" DNA, short tandem repeats consisting of (GATA)n, or its compliment, were found in varied metazoan eukaryotic genomes but were rare in yeast and bacterial genomes. The (GATA)n sequence was found in cDNAs encoding mRNAs with known functions. At least 16 of 18 such transcripts encode membrane-associated proteins including: plasma membranes, synapses, mitochondrial membranes, nuclear envelopes, and brush border membranes. Flanking sequences were diverse but (GATA)n sequences clustered around 500 bases from stop codons. The (GATA)n sequences occurred in both orientations and showed constrained polymorphism. In sets of splice variants with and without (GAUA)n, the STR containing transcripts were the most abundant. These observations suggest that (GATA)n sequences probably function. In many cases, the function may be to encode post-transcriptional signals for mRNAs encoding membrane-associated proteins.
Asunto(s)
ARN Mensajero/fisiología , Secuencias Repetidas en Tándem , Animales , Bacterias/genética , Secuencia de Bases , ADN/genética , Bases de Datos Genéticas , Datos de Secuencia Molecular , Polimorfismo Genético , ARN Mensajero/genética , Saccharomyces cerevisiae/genéticaRESUMEN
The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.
Asunto(s)
Dolor Pélvico/clasificación , Dolor Pélvico/diagnóstico , Prostatitis/clasificación , Prostatitis/diagnóstico , Enfermedad Crónica , Consensus Development Conferences, NIH as Topic , Humanos , Recuento de Leucocitos , Leucocitos/metabolismo , Masculino , Próstata/metabolismo , Semen/química , Semen/metabolismo , Sensibilidad y Especificidad , Estados Unidos , UrinálisisRESUMEN
Although bacterial prostatitis is a common diagnosis, well documented infections of the prostate are uncommon. Culture studies of prostate tissue led our group to hypothesize that bacterial colonization/invasion of the prostate gland might occur more commonly than is appreciated by standard microbiological techniques. Specific polymerase chain reaction (PCR) assays were used for each of the pathogens previously implicated in chronic prostatitis as well as broad-spectrum PCR assays to identify tetracycline resistance genes and bacterial ribosomal-encoding genes (16S rDNAs), followed by cloning and sequencing of the PCR products. Only ten (8%) of the 135 patients with chronic prostatitis had positive specific PCR assays including: Mycoplasma genitalium in four men, Chlamydia trachomatis in three and Trichomonas vaginalis in two, as well as one man positive for both M. genitalium and C. trachomatis. In contrast to the specific probes, the broad-spectrum PCR assays had a substantial proportion of positives. We found evidence of tetracycline resistance in 25% of patients. 16S rDNA-encoding sequences in 77% of the subjects. The tetracycline resistance positives were a subset of the 16S rDNA positive patients. Patients with 16S rDNA-encoding sequences were significantly more likely to have expressed prostatic secretion leukocytes. Many patients with chronic prostatitis/chronic pelvic pain syndrome have a wide variety of bacterial DNA-encoding sequences despite extensive negative microbiological investigations. Understanding the precise role of infection in this syndrome may well lead to better methods to elucidate the microbiology of the prostate in health and disease.
Asunto(s)
Infecciones Bacterianas/complicaciones , Prostatitis/etiología , Bacterias/clasificación , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Enfermedad Crónica , Humanos , Masculino , Prostatitis/microbiologíaRESUMEN
PURPOSE: There is a pressing need to determine the causes and consequences of, and optimal therapy for the chronic prostatitis-chronic pelvic pain syndrome. MATERIALS AND METHODS: New data suggest that bacterial infection may be critical in some patients. We examined the rationale for and technical approaches to hypothesis driven studies of bacteria in the chronic prostatitis-chronic pelvic pain syndrome. RESULTS: The first hypothesis was that patients with the chronic prostatitis-chronic pelvic pain syndrome have prostatic bacteria that distinguish them from controls. In pilot studies patients with inflamed expressed prostatic secretions were more likely to have bacterial DNAs, that is 16S ribosomal DNAs. Current goals are to clone, sequence and compare ribosomal DNAs from patients and controls to determine which bacteria are most specific to the chronic prostatitis-chronic pelvic pain syndrome and which should be targeted in clinical trials. The second hypothesis was that bacterial viability correlates with the severity of the chronic prostatitis-chronic pelvic pain syndrome. Quantitative assays for bacterial elongation factor messenger RNA (tufA messenger RNA) provide tools to correlate bacterial viability with patient characteristics, will provide insights into the potential value of antimicrobial therapy and identify characteristics that distinguish patients most likely to respond. The third hypothesis was that patients with prostatic bacteria have similar bacteria in expressed prostatic secretions or on seminal fluid analysis and, furthermore, these bacteria differ from bacteria in controls. These studies would determine whether expressed prostatic secretions or seminal fluid analysis can be used to identify prostatic bacteria and may result in clinical methods for noninvasive diagnosis of prostatic infection. CONCLUSIONS: These studies should provide important insights into the causes of the chronic prostatitis-chronic pelvic pain syndrome and may elucidate optimal clinical evaluation and treatment in patients.