Rho- kinase (ROK)-myosin light chain phosphatase (MLCP) pathway and protein kinase C potentiated inhibitor (CPI-17)-MLCP pathway have been proposed as two major pathways for the regulation of smooth muscle contraction.20,21 ROK is a serine/threonine kinase that was believed to play an important role in a variety of cellular functions. Caldesmon (CaD) is one of the proteins that regulate the actin cytoskeleton. There are two CaD dominant isoforms: l-CaD and h-CaD (low and high molecular sizes, respectively).21 In the bladder I/R animal DAPT manufacturer study,22 ROK increased at 2-h reperfusion, decreased

significantly following 1-week reperfusion, and returned to control by 2-week reperfusion. MLCK expression significantly decreased as early as ischemia alone and did not recover after reperfusion.

Short-term reperfusion induced ROK overexpression in the bladder muscle layer, indicating a compensatory effect of the bladder in response to the ischemic damage. This suggested that ROK in bladder muscle may be upregulated as a compensatory mechanism to increase Ca2+ sensitization. Decreased ROK levels following 1 week of reperfusion indicated free radical damage to the bladder wall and loss of the compensatory click here ability to sustain bladder contractility. For CaD expressions in the muscle layer, both CaD isoforms had different expressions. h-CaD decreased at ischemia alone and 2-h reperfusion, but significantly increased at 2-week reperfusion; whereas l-CaD significantly decreased at 2-week reperfusion. Decreased h-CaD isoform during early ischemia may be associated with remodeling the cytoskeletal structure and interfering with the generation and maintenance of the additional forces required for ischemia-induced bladder dysfunction. Lin et al. proved the development of I/R injury following bladder outlet obstruction. In

a rabbit obstruction model they found that the content of malondialdehyde, a product of lipid peroxidation induced by I/R, of the detrusor was increased after BOO with persistently increased activity of superoxide dismutase Phospholipase D1 of detrusor mitochondria. The content of high-energy phosphates and the contractility of the detrusor were also decreased. These findings indicate that BOO increases generation of reactive oxygen species (ROS) and enhances lipid peroxidation of detrusor mitochondria. The resulting mitochondrial damages lead to persistently decreased energy production and impaired detrusor function.23 As I/R is the main etiologic factor in several bladder dysfunctions, reducing the level of I/R damage would significantly diminish the progression of bladder dysfunction. Recently, several studies have focused on natural compounds for protecting against I/R-induced bladder dysfunction, such as Antrodia camphorate (AC), coenzyme Q10 (CoQ10), and alpha-lipoic acid (α-LA).