Mechanism of Androgen-Independent Stromal Proliferation in Benign Prostatic Hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is a chronic proliferative disease showing stromal-dominant proliferation. However, the detailed proliferation mechanism has remained unclear. Although aging and androgen have been reported as definitive risk factors for BPH, recent studies have focused on the involvement of androgen-independent factors. Androgen-independent factors include ischemia, oxidative stress, metabolic syndrome, infection, autoimmune reactions, and inflammation, with inflammation in BPH tissues playing a central role in the BPH proliferative process. Inflammation in BPH tissues by various factors finally leads to tissue remodeling and stromal proliferation through the wound healing process of the prostate. To elucidate the proliferative mechanism of BPH, a study using whole-genome gene expression analysis in a stromal-dominant BPH rat model was performed and showed that immune response-related pathways and complement classical pathways are activated. Furthermore, expression analysis using this BPH rat model showed that the autoimmune reaction triggered complement pathway activation in the proliferative process of BPH. BPH is a multifactorial disease, and understanding the role of androgen-independent factors including immune responses contributes to elucidating the pathogenesis of BPH. Androgen-independent factors may lead to new therapeutic targets for BPH, and further development of this research is expected.

Special Issue “Molecular Immunology of the Male Reproductive System”

“…Benign prostatic hyperplasia is also a major issue both in andrology and urology. New therapeutic targets may be evaluated in terms of androgen-independent autoimmunolgic reactions that can trigger BPH [5]. Lastly, in an article on the role of mononuclear phagocytes, the authors highlight their function as a control point for the maintenance of the immune tolerance of the testis and epididymis, as well as for the elimination of pathogens, which again is of high clinical relevance [6].…”