How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI‐RS 2018

Khullar, Vikram; Digesu, G. Alessandro; Veit‐Rubin, Nikolaus; Sahai, Amit; Rahnama’i, Mohammad Sajjad; Tarcan, Tufan; Chermansky, Christopher; Dmochowski, Roger R.

doi:10.1002/nau.24245

Cited by 7 publications

(9 citation statements)

References 70 publications

(133 reference statements)

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“…Bladder lesions may be removed endosurgically, but in many cases, surgery has no lasting effect on bladder pain. The quality of life is severely impaired in this patient group [6] , [9] . The molecular basis of the BPS has remained an enigma, however, precluding the development of more specific therapies [10] .…”

Section: Introductionmentioning

confidence: 81%

Immunomodulation—A Molecular Solution to Treating Patients with Severe Bladder Pain Syndrome?

Wullt¹,

Butler²,

Ambite³

et al. 2021

European Urology Open Science

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Background Patients with bladder pain syndrome experience debilitating pain and extreme frequency of urination. Numerous therapeutic approaches have been tested, but as the molecular basis of disease has remained unclear, specific therapies are not available. Objective Recently, a systematic gene deletion strategy identified interleukin-1 (IL-1) hyperactivation as a cause of severe cystitis in a murine model. Treatment with an IL-1 receptor antagonist (IL-1RA) restored health in genetically susceptible mice, linking IL-1–dependent inflammation to pain and pathology in the bladder mucosa. The study objective was to investigate whether IL-1RA treatment might be beneficial in patients with bladder pain syndrome. Design, setting, and participants Patients diagnosed with bladder pain syndrome were invited to participate and subjected to daily IL-1RA injections for 1 wk, followed by a treatment break. Patients with other urological disorders accompanied by pain were included as controls. Outcome measurements and statistical analysis When symptoms returned, treatment was resumed and responding patients were maintained on treatment long term, with individualized dosing regimens. Symptom scores were recorded and molecular effects were quantified by neuropeptide and gene expression analysis. DNA samples were subjected to exome genotyping. Results and limitations IL-1RA treatment reduced bladder pain and the frequency of urination in 13/17 patients ( p < 0.001). Substance P levels in urine were lowered, and responders returned to a more normal lifestyle. Neuroinflammatory-dependent and IL-1–dependent gene networks were inhibited, as well as regulators of innate immunity. Genotyping revealed disease-associated IL1R1, NLRP3 , and IL1RN DNA sequence variants in the responders. Controls did not benefit from IL-1RA treatment, except for one patent with cystitis cystica. Conclusions In this clinical study, IL-1RA treatment is proposed to reduce chronic bladder pain, immediately and in the long term. Despite the limited number of study patients, the potent acute effect and lasting symptom relief indicate that this therapeutic approach may be worth exploring in controlled clinical trials. Patient summary Treatment with an interleukin-1 (IL-1) receptor antagonist is proposed for treating bladder pain syndrome, as it can result in symptom relief and increase quality of life. Reduced neuroinflammation and IL-1 signaling provided molecular evidence of the treatment effects.

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Section: Introductionmentioning

confidence: 81%

Immunomodulation—A Molecular Solution to Treating Patients with Severe Bladder Pain Syndrome?

Wullt¹,

Butler²,

Ambite³

et al. 2021

European Urology Open Science

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“…However, there is a scanty database of IC/BPS treatment results. Despite the pathogenetic validity of the use of bladder hydrodistension in the treatment of IC/BPS, there are practically no controlled randomized trials regarding the effectiveness of this treatment method [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations and results of cystoscopy in women with interstitial cystitis/bladder pain syndrome

Sholan¹

2020

North Clin Istanbul

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“…All guidelines recommend using patient education to improve patients' understanding of the disease, while also maintaining realistic goals. Oral medical treatment and subsequent intravesical instillation or bladder wall injection follow the failure of first-line management [13,26]. The principles of pharmacotherapy for the treatment of IC/BPS are based on (1) controlling the dysfunctional epithelium by continual replenishment of the glycosaminoglycan layer; (2) mast cell deactivation and suppression of allergies; (3) tricyclic antidepressants; (4) anticholinergics or β3 agonists; (5) painkillers and nonsteroidal anti-inflammatory drugs; and (6) intravesical botulinum toxin injection and dimethyl sulfoxide instillation.…”

Section: Current Treatment Of Ic/bpsmentioning

confidence: 99%

New Frontiers or the Treatment of Interstitial Cystitis/Bladder Pain Syndrome - Focused on Stem Cells, Platelet-Rich Plasma, and Low-Energy Shock Wave

et al. 2020

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Interstitial cystitis/bladder pain syndrome (IC/BPS), which is characterized by bladder pain and irritative voiding symptoms, is a frustrating disease without effective treatment. The cause is still largely not understood, although urothelium ischemia/hypoxia, apoptosis, denudation, and infiltration of inflammatory cells are common histopathological findings. The current uncertainty regarding the etiology and pathology of IC/BPS has a negative impact on its timely and successful treatment; therefore, the development of new treatment modalities is urgently needed. Herein, we present advances in our knowledge on this topic and review the potential application of regenerative medicine for the treatment of IC/BPS. This article provides information on the basic characteristics and clinical evidence of stem cells, platelet-rich plasma (PRP), and low-energy shock waves (LESWs) based on a literature review with a search strategy for articles related to IC/BPS, stem cells, PRP, and LESW published in MEDLINE and PubMed. Stem cells, PRP, and LESW, which modulate inflammatory processes and promote tissue repair, have been proven to improve bladder regeneration, relieve bladder pain, inhibit bladder inflammation, and increase bladder capacity in some preclinical studies. However, clinical studies are still in their infancy. Based on the mechanisms of action of stem cells, PRP, and LESW documented in many preclinical studies, the potential applications of regenerative medicine for the treatment of IC/BPS is an emerging frontier of interest. However, solid evidence from clinical studies remains to be obtained.

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How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI‐RS 2018

Cited by 7 publications

References 70 publications

Immunomodulation—A Molecular Solution to Treating Patients with Severe Bladder Pain Syndrome?

Immunomodulation—A Molecular Solution to Treating Patients with Severe Bladder Pain Syndrome?

Clinical manifestations and results of cystoscopy in women with interstitial cystitis/bladder pain syndrome

New Frontiers or the Treatment of Interstitial Cystitis/Bladder Pain Syndrome - Focused on Stem Cells, Platelet-Rich Plasma, and Low-Energy Shock Wave

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