Intravesical injections of autologousplatelet‐richplasma for the treatment of refractory interstitial cystitis

Abstract

The urothelium acts as a barrier for the urinary bladder that prevents the influx of urinary toxic substances, electrolytes, urea nitrogen, and pathogens into the circulation. Acute or chronic inflammation of the urinary bladder may impair the regenerative function of urothelial cells and thus urothelial cell differentiation. In an inflamed bladder wall, mature apical cells are defective, resulting in impaired barrier function and thus increased urothelial permeability. This is considered to be the potential mechanism of the symptom trigger in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Previous studies have revealed that increased bladder inflammation, impaired urothelial cell maturation, a defective umbrella cell barrier, and defective junction proteins are prominent in IC/BPS bladders. Platelet‐rich plasma (PRP) contains many growth factors and cytokines that are essential proteins for modulating inflammation and promoting tissue regeneration and thus wound healing. As such, PRP has been used as a regenerative therapy in many medical fields. Our preliminary studies have demonstrated that multiple intravesical PRP injections could improve symptoms in 70% of IC/BPS patients. Repeated PRP treatments also improve junctional protein, increase cytoskeleton protein expression, and decrease urinary inflammatory proteins. These preliminary results suggest that PRP injections might reduce bladder inflammation and improve urothelial cell regeneration in IC/BPS patients. This article reviews recently published clinical and basic research on the treatment potential of PRP for IC/BPS patients.

Nanocluster-antibody-drug conjugates (NADC) as an intravesical precision theranostic agent for interstitial cystitis

“…The human normal urothelial cell line SV-HUC-1 used in this study was from the Cell Resource Center of the Chinese Academy of Sciences (Shanghai, China). The integrity and permeability of cellular monolayers were tested with immortalized human uroepithelial SV-HUC-1 cells by seeding into the upper chambers of 12-well plates at a density of 5 × 10 4 cells per well. Over time, TEER was periodically measured with the RE1600 Epithelial Volt/Ohm Meter (Beijing Jingshi Technology).…”

“…Nevertheless, current intravesical therapies, such as guideline-recommended lidocaine, heparin, and DMSO, only provide temporary symptom relief and risk systemic toxicity through leaking into circulation. Moreover, these intravesical agents demand frequent instillations owing to low bladder retention, urinary washout, and poor urothelium entry, which significantly reduce therapeutic efficacy 4 . Therefore, there is a pressing need to develop IC-specific targeted agents to achieve sustained efficacy, preferably with imaging features to reliably diagnose IC, visualize drug distribution patterns, and reduce unnecessary examinations.…”

Stem cell therapy for interstitial cystitis/bladder pain syndrome

“…Platelet-rich plasma injection has proven effective in multiple Taiwanese trials. 9 Preclinical investigations have also been reported to expand indications of existing tyrosine kinase inhibitors based on the hypothesis that Hunner lesions are associated with abnormal vasculature. 17 Considering the chronic and incurable nature of IC/BPS, stem cell therapy's regenerative feature might be a feasible option for treating IC/BPS.…”

“…However, these major operations are invasive, and in some unfortunate cases, no significant improvement in clinical symptoms (mainly pain) has been reported. 7 Clinical trials on experimental approaches such as stem cell therapy, low-energy shockwave therapy, 8 intravesical platelet-rich plasma (PRP) injection, 9 and antiviral therapy are offered as a last resort for bladder preservation.…”