Reviving Cav1.2 as an attractive drug target to treat bladder dysfunction

Inhibition of bladder contraction with antimuscarinics is a common approach to treat bladder hyperactivity, and the L-type voltage-gated calcium channel alpha(1C) (Cav1.2) is crucial for bladder contractility. Therefore, strategies aimed at inhibiting Cav1.2 appear warranted. However, multiple clinical trials that attempted to treat bladder overactivity with calcium channel blockers (CCBs) have been unsuccessful, creating an unsolved mystery. In contrast, cardiologists and epidemiologists have reported strong associations between CCB use and bladder hyperactivity, opposing expectations of urologists. Recent findings from our lab offer a potential explanation. We have demonstrated that ketamine which can cause cystitis, functions, like nifedipine, as a Cav1.2 antagonist. We also show that a Cav1.2 agonist which potentiates muscle contraction, rather than antagonizing it, can increase the volume of voids and reduce voiding frequency. This perspective will discuss in detail the unsuccessful urological trials of CCBs and the promise of Cav1.2 agonists as potential novel therapies for bladder dysfunctions.

Automated summary

Inhibition of bladder contraction with antimuscarinics is a common approach for treating bladder hyperactivity. The L-type voltage-gated calcium channel alpha(1C) (Cav1.2) plays a crucial role in bladder contractility. However, clinical trials using calcium channel blockers (CCBs) for treating bladder overactivity have been unsuccessful, contrary to expectations. Recent findings suggest that ketamine and nifedipine can function as Cav1.2 antagonists, and a Cav1.2 agonist can increase void volume and reduce voiding frequency. This perspective discusses the unsuccessful use of CCBs in urological trials and the potential of Cav1.2 agonists as novel therapies for bladder dysfunctions.