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Bladder cancer, inflammageing and microbiomes

Abstract

Ageing is correlated with elevated bladder cancer incidence, morbidity and mortality. Advanced age is also associated with elevated markers of chronic inflammation and perturbations in gut and urinary tract microbiota. One reason for the increased incidence and mortality of bladder cancer in the elderly might be that age-associated changes in multiple microbiomes induce systemic metabolic changes that contribute to immune dysregulation with potentially tumorigenic effects. The gut and urinary microbiomes could be dysregulated in bladder cancer, although the effect of these changes is poorly understood. Each of these domains — the immune system, gut microbiome and urinary microbiome — might also influence the response of patients with bladder cancer to treatment. Improved understanding of age-related alterations to the immune system and gut and urinary microbiomes could provide possible insight into the risk of bladder cancer development and progression in the elderly. In patients with bladder cancer, improved understanding of microbiota might also provide potential targets for therapeutic intervention.

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Fig. 1: Microbiomes in bladder cancer and their potential connections to inflammation.
Fig. 2: Proposed mechanisms of age-associated dysbiosis and effect on systemic markers of inflammation.
Fig. 3: Hypothetical links between systemic inflammation, urothelial proliferation and bladder cancer.

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Acknowledgements

This work is funded in part by the Albert Charitable Trust (J.A.T. III), American Urological Association Research Scholar Award (B.L.W.) and National Institutes of Health (R01CA185322 (S.U.)).

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A.M., B.L.W. and J.A.T. III researched data for the article. All authors contributed substantially to discussion of the content. A.M., B.L.W. and J.A.T. III wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Martin, A., Woolbright, B.L., Umar, S. et al. Bladder cancer, inflammageing and microbiomes. Nat Rev Urol 19, 495–509 (2022). https://doi.org/10.1038/s41585-022-00611-3

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