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Transitional epithelium also known as urothelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching (stretchable epithelium). The transitional epithelium usually appears cuboidal when relaxed and squamous when stretched. This tissue consists of multiple layers of
epithelial Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
cells which can contract and expand in order to adapt to the degree of distension needed. Transitional epithelium lines the organs of the
urinary system The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, co ...
and is known here as urothelium. The
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
for example has a need for great distension.


Structure

The appearance of transitional epithelium differs according to its cell layer. Cells of the basal layer are
cuboidal Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
(cube-shaped), or
columnar Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
(column-shaped), while the cells of the superficial layer vary in appearance depending on the degree of distension. These cells appear to be cuboidal with a domed apex when the organ or the tube in which they reside is not stretched. When the organ or tube is stretched (such as when the bladder is filled with urine), the tissue compresses and the cells become stretched. When this happens, the cells flatten, and they appear to be
squamous Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...
and irregular.


Cell layers

Transitional epithelium is made up of three types of cell layers: basal, intermediate, and superficial.Monis, B., & Zambrano, D. (1968). Ultrastructure of transitional epithelium of man. Zeitschrift für Zellforschung und Microscopical Anatomie, 87(1), 101-117. The basal layer fosters the epithelial stem cells in order to provide constant renewal of the epithelium.Osborn, S. L., & Kurzrock, E. A. (2015). Production of Urothelium from Pluripotent Stem Cells for Regenerative Applications. Current Urology Reports, 16(1), 1+. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA390522720&v=2.1&u=clemsonu_main&it=r&p=AONE&sw=w&asid=bf6961c15c9b9523113dee93fd8df89c These cells' cytoplasm is rich in tonofilaments and
mitochondria A mitochondrion (; ) is an organelle found in the cells of most Eukaryotes, such as animals, plants and fungi. Mitochondria have a double membrane structure and use aerobic respiration to generate adenosine triphosphate (ATP), which is use ...
; however, they contain few
rough endoplasmic reticulum The endoplasmic reticulum (ER) is, in essence, the transportation system of the eukaryotic cell, and has many other important functions such as protein folding. It is a type of organelle made up of two subunits – rough endoplasmic reticulum ( ...
. The tonofilaments play a role in the attachment of the basal layer to the basement membrane via
desmosomes A desmosome (; "binding body"), also known as a macula adherens (plural: maculae adherentes) (Latin for ''adhering spot''), is a cell structure specialized for cell-to-cell adhesion. A type of junctional complex, they are localized spot-like adhe ...
. The intermediate cell layer is highly proliferative and, therefore, provides for rapid cell regeneration in response to injury or infection of the organ or tube in which it resides. These cells contain a prominent
Golgi apparatus The Golgi apparatus (), also known as the Golgi complex, Golgi body, or simply the Golgi, is an organelle found in most eukaryotic cells. Part of the endomembrane system in the cytoplasm, it packages proteins into membrane-bound vesicles insi ...
and an array of membrane-bound vesicles. These function in the packaging and transport of proteins, such as keratin, to the superficial cell layer. The cells of the superficial cell layer that lines the lumen are known as
facet cell Facet cells (also known as umbrella cells, capping cells, superficial urotheliocytes) are a type of cells located in the renal pelvis, the ureters,and the urethra. Umbrella cells form the outermost layer of the urothelium, which is a special typ ...
s or ''umbrella cells''. This layer is the only fully differentiated layer of the epithelium. It provides an impenetrable barrier between the lumen and the bloodstream, so as not to allow the bloodstream to reabsorb harmful wastes or pathogens. All transitional epithelial cells are covered in
microvilli Microvilli (singular: microvillus) are microscopic cellular membrane protrusions that increase the surface area for diffusion and minimize any increase in volume, and are involved in a wide variety of functions, including absorption, secretion, ce ...
and a fibrillar mucous coat. The epithelium contains many intimate and delicate connections to neural and connective tissue. These connections allow for communication to tell the cells to expand or contract. The superficial layer of transitional epithelium is connected to the basal layer via cellular projections, such as intermediate filaments protruding from the cellular membrane. These structural elements cause the epithelium to allow distension; however, these also cause the tissue to be relatively fragile and, therefore, difficult to study. All cells touch the basement membrane.


Cell membrane

The urothelium is the most impermeable membrane in the mammalian body. Because of its importance in acting as an osmotic barrier between the contents of the urinary tract and the surrounding organs and tissues, transitional epithelium is relatively impermeable to water and salts. This impermeability is due to a highly keratinized cellular membrane synthesized in the Golgi apparatus. The membrane is made up of a hexagonal lattice put together in the Golgi apparatus and implanted into the surface of the cell by reverse pinocytosis, a type of exocytosis.Firth, J. A., & Hicks, R. M. (1973). Interspecies variation in the fine structure and enzyme cytochemistry of mammalian transitional epithelium. Journal of Anatomy, 116(Pt 1), 31–43. The cells in the superficial layer of the transitional epithelium are highly differentiated, allowing for maintenance of this barrier membrane. The basal layer of the epithelium is much less differentiated; however, it does act as a replacement source for more superficial layer. While the Golgi complex is much less prominent in the cells of the basal layer, these cells are rich in cytoplasmic proteins that bundle together to form
tonofibrils Tonofibrils are cytoplasmic protein structures in epithelial tissues that converge at desmosomes and hemidesmosomes. They consist of fine fibrils in epithelial cells that are anchored to the cytoskeleton. They were discovered by Rudolf Heidenhain ...
. These tonofibrils converge at
hemidesmosomes Hemidesmosomes are very small stud-like structures found in keratinocytes of the epidermis of skin that attach to the extracellular matrix. They are similar in form to desmosomes when visualized by electron microscopy, however, desmosomes attach to ...
to attach the cells at the basement membrane.Hicks, R. (1965). The Fine Structure Of The Transitional Epithelium Of Rat Ureter. ''The Journal of Cell Biology,'' ''26''(1), 25-48. Retrieved November 25, 2014, from http://jcb.rupress.org/content/26/1/25.abstract


Function

The transitional epithelium cells stretch readily in order to accommodate fluctuation of volume of the liquid in an organ (the distal part of the urethra becomes non-keratinized stratified squamous epithelium in females; the part that lines the bottom of the tissue is called the
basement membrane The basement membrane is a thin, pliable sheet-like type of extracellular matrix that provides cell and tissue support and acts as a platform for complex signalling. The basement membrane sits between epithelial tissues including mesothelium and ...
). Transitional epithelium also functions as a barrier between the lumen, or inside hollow space of the tract that it lines and the bloodstream. To help achieve this, the cells of transitional epithelium are connected by tight junctions, or virtually impenetrable junctions that seal together to the cellular membranes of neighboring cells. This barrier prevents re-absorption of toxic wastes and pathogens by the bloodstream.


Clinical significance

Urothelium is susceptible to carcinoma. Because the bladder is in contact with urine for extended periods, chemicals that become concentrated in the urine can cause
bladder cancer Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become mal ...
. For example,
cigarette smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believe ...
leads to the concentration of carcinogens in the urine and is a leading cause of bladder cancer.
Aristolochic acid Aristolochic acids () are a family of carcinogenic, mutagenic, and nephrotoxic phytochemicals commonly found in the flowering plant family Aristolochiaceae (birthworts). Aristolochic acid (AA) I is the most abundant one. The family Aristolochiacea ...
, a compound found in plants of the family
Aristolochiaceae The Aristolochiaceae () are a family, the birthwort family, of flowering plants with seven genera and about 400 known species belonging to the order Piperales. The type genus is '' Aristolochia'' L. Description They are mostly perennial, her ...
, also causes DNA mutations and is a cause of liver, urothelial and bladder cancers. Occupational exposure to certain chemicals is also a risk factor for bladder cancer. This can include
aromatic amine In organic chemistry, an aromatic amine is an organic compound consisting of an aromatic ring attached to an amine. It is a broad class of compounds that encompasses anilines, but also many more complex aromatic rings and many amine substituents ...
s (aniline dye),
polycyclic aromatic hydrocarbon A polycyclic aromatic hydrocarbon (PAH) is a class of organic compounds that is composed of multiple aromatic rings. The simplest representative is naphthalene, having two aromatic rings and the three-ring compounds anthracene and phenanthrene. ...
s, and diesel engine exhaust.


Carcinoma

Carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal ...
is a type of cancer that occurs in epithelial cells.
Transitional cell carcinoma Transitional cell carcinoma, also called urothelial carcinoma, is a type of cancer that typically occurs in the urinary system. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. It accounts for 95% of ...
is the leading type of
bladder cancer Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become mal ...
, occurring in 9 out of 10 cases.American Cancer Society. (2014). Bladder cancer. Retrieved November 25, 2014, from http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-what-is-bladder-cancer It is also the leading cause of cancer of the ureter, urethra, and
urachus The urachus is a fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord. The fibrous remnant lies in the space of Retzius, between the transverse fascia anteriorly and ...
, and the second leading cause of cancer of the kidney. Transitional cell carcinoma can develop in two different ways. Should the transitional cell carcinoma grow toward the inner surface of the bladder via finger-like projections, it is known as papillary carcinoma. Otherwise, it is known as flat carcinoma. Either form can transition from non-invasive to invasive by spreading into the muscle layers of the bladder. Transitional cell carcinoma is commonly multifocal, more than one tumor occurring at the time of diagnosis. Transitional cell carcinoma can metastasize, or spread to other parts of the body via the surrounding tissues, the lymph system, and the bloodstream. It can spread to the tissues and fat surrounding the kidney, the fat surrounding the ureter, or, more progressively, lymph nodes and other organs, including bone. Common risk factors of transitional cell carcinoma include long-term misuse of pain medication, smoking, and exposure to chemicals used in the making of leather, plastic, textiles, and rubber.Transitional Cell Cancer. (2012, April 13). Retrieved December 14, 2014, from https://my.clevelandclinic.org/health/diseases_conditions/hic_Transitional_Cell_Cancer_of_Renal_Pelvis_and_Ureter Transitional cell carcinoma patients have a variety of treatment options. These include nephroureterectomy, or the removal of kidney, ureter, and bladder cuff, and segmental resection of the ureter. This is an option only when the cancer is superficial and infects only the bottom third of the ureter. The procedure entails removing the segment of cancerous ureter and reattaching the end. Patients with advanced bladder cancer or disease, also often look to bladder reconstruction as a treatment. Current methods of bladder reconstruction include the use of gastrointestinal tissue. However, while this method is effective in improving the function of the bladder, it can actually increases the risk of cancer, and can cause other complications, such as infections, urinary stones, and electrolyte imbalance. Therefore, other methods loom in the future. For example, current research paves the way for use of pluripotent stem cells to derive urothelium, as they are highly and indefinitely proliferative in vitro (i.e. outside of the body).


Interstitial cystitis

Interstitial cystitis Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right aw ...
(IC) a type of ''painful bladder syndrome'' is a chronic disease of the bladder that causes feelings of pressure and pain in the bladder among other symptoms which can range from mild to severe. Urinary frequency and urgency are the most common symptoms associated with the disease. The exact causes of IC/BPS are unknown, but there is evidence of an association between increased permeability of the urothelium and IC. Since the purpose of the urothelium is to act as a highly resistant barrier, the loss of this function has serious clinical implications. Many patients with IC have exhibited a loss of umbrella cells.


Urothelial lesions

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Papillary urothelial lesion Papilla (Latin, 'nipple') or papillae may refer to: In animals * Papilla (fish anatomy), in the mouth of fish * Basilar papilla, a sensory organ of lizards, amphibians and fish * Dental papilla, in a developing tooth * Dermal papillae, part of ...
s ** Papillary urothelial hyperplasia ** Urothelial papilloma ** Papillary urothelial neoplasm of low malignant potential ( PUNLMP) ** Low-grade papillary urothelial carcinoma ** High-grade papillary urothelial carcinoma ** Invasive urothelial carcinoma * Flat urothelial lesions ** Reactive urothelial atypia ** Urothelial inverted papilloma ** Urothelial atypia of unknown significance ** Urothelial dysplasia ** Urothelial carcinoma in situ * Invasive
urothelial carcinoma Transitional epithelium also known as urothelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching (stretchable epithelium). The transitional epithelium usually appears ...
** Invasive urothelial carcinoma ( NOS) ** Urothelial carcinoma with inverted growth pattern **
Urothelial carcinoma with squamous differentiation Transitional epithelium also known as urothelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching (stretchable epithelium). The transitional epithelium usually appears ...
** Urothelial carcinoma with villoglandular differentiation ** Urothelial carcinoma, micropapillary variant ** Urothelial carcinoma, lymphoepithelioma-like variant ** Urothelial carcinoma, clear cell (glycogen-rich) variant ** Urothelial carcinoma, lipoid cell variant ** Urothelial carcinoma with syncitiotrophoblastic giant cells ** Urothelial carcinoma with rhabdoid differentiation ** Urothelial carcinoma similar to giant cell tumor of bone


Gallery

File:Illu epithelium.jpg, Types of epithelium File:Illu_transitional_epithelium.svg, Schematic view of transitional epithelium File:Gray1141.png, Vertical section of bladder wall. File:Gray1134.png, Transverse section of ureter.


References


Bibliography

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External links


Histology at utmb.edu
* - "ureter" * - "urinary bladder" * - "Transitional Epithelium", Ureter * "ureter"
www.urothelium.com is an online resource for information about Human Urothelium and the "Biomimetic Urothelium"
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{{Authority control Epithelial cells