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A Feasibility Study to Evaluate Changes in Urinary Metabolites after OnabotulinumtoxinA Injection for Refractory
Laura M Tellechea1, Samantha Freeman2, Ilir Agalliu2,3
1Department of Obstetrics & Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Abstract:
Metabolomics analysis of urine before and after overactive bladder (OAB) treatment may demonstrate a unique molecular profile, allowing predictions of responses to treatment. This feasibility study aimed to correlate changes in urinary metabolome with changes in OAB symptoms after intravesical onabotulinumtoxinA (BTX-A) injections for refractory OAB. Women 18 years or older with non-neurogenic refractory OAB were recruited to complete OAB-V8 questionnaires and submit urine samples before and after 100 units intravesical BTX-A injection. Samples were submitted to CE-TOFMS metabolomics profiling. Data were expressed as percent of change from pre-treatment and were correlated with OAB-V8 score improvement. Urinary metabolite changes in the OAB-V8 groups were compared using the Kruskal-Wallis test, and associations between metabolites and OAB-V8 scores were examined using quantile regression analysis. Of 61 urinary metabolites commonly detected before and after BTX-A, there was a statistically significant decrease in adenosine and an increase in N8-acetylspermidine and guanidinoacetic acid levels associated with OAB score improvement, suggesting that intravesical BTX-A injection modifies the urinary metabolome. These urinary metabolites could provide insight into OAB pathophysiology and help identify patients who would benefit most from chemodenervation.
Insights
Urinary metabolomics may predict overactive bladder (OAB) treatment success. Changes in specific metabolites like adenosine, N8-acetylspermidine, and guanidinoacetic acid correlate with symptom improvement after onabotulinumtoxinA (BTX-A) injections.
Area of Science:
- Urology
- Metabolomics
- Biochemistry
Background:
- Overactive bladder (OAB) is a common condition impacting quality of life.
- Refractory OAB often requires advanced treatments like onabotulinumtoxinA (BTX-A) injections.
- Predicting treatment response in OAB is crucial for personalized medicine.
Purpose of the Study:
- To investigate the feasibility of using urinary metabolomics to predict treatment response in patients with refractory overactive bladder (OAB).
- To correlate changes in the urinary metabolome with symptom improvement after intravesical onabotulinumtoxinA (BTX-A) injections.
Main Methods:
- Feasibility study involving women with non-neurogenic refractory OAB.
- Urine samples collected pre- and post-intravesical BTX-A (100 units) treatment.
- CE-TOFMS metabolomics profiling and OAB-V8 questionnaire for symptom assessment.
Main Results:
- Significant changes observed in 61 urinary metabolites post-BTX-A treatment.
- Decreased adenosine levels and increased N8-acetylspermidine and guanidinoacetic acid levels correlated with OAB symptom improvement.
- Statistical analysis included Kruskal-Wallis test and quantile regression.
Conclusions:
- Intravesical BTX-A injection alters the urinary metabolome in patients with refractory OAB.
- Specific urinary metabolites may serve as biomarkers for predicting treatment efficacy.
- These findings offer insights into OAB pathophysiology and patient selection for chemodenervation therapy.
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