Treating BCG-Induced Cystitis with Combined Chondroitin and Hyaluronic Acid Instillations in Bladder Cancer
Por:
Pichler, R, Stäblein, J, Mari, A, Afferi, L, D'Andrea, D, Marcq, G, del Giudice, F, Soria, F, Caño-Velasco, J, Subiela, JD, Gallioli, A, Tully, KH, Mori, K, Herms, A, Pradere, B, Moschini, M, Mertens, LS, Thurnher, M
Publicada:
1 abr 2024
Resumen:
In non-muscle invasive bladder cancer, Bacillus Calmette-Guerin (BCG) responders benefit from strong Th1-type inflammatory and T cell responses mediating tumor rejection. However, the corresponding lack of anti-inflammatory Th2-type immunity impairs tissue repair in the bladder wall and facilitates the development of cystitis, causing urinary pain, urgency, incontinence, and frequency. Mechanistically, the leakage of the glycosaminoglycan (GAG) layer enables an influx of potassium ions, bacteria, and urine solutes towards the underlying bladder tissue, promoting chronic inflammation. Treatments directed towards re-establishing this mucopolysaccharide-based protective barrier are urgently needed. We discuss the pathomechanisms, as well as the therapeutic rationale of how chondroitin and hyaluronic acid instillations can reduce or prevent BCG-induced irritative bladder symptoms. Moreover, we present a case series of five patients with refractory BCG-induced cystitis successfully treated with combined chondroitin and hyaluronic acid instillations.
Filiaciones:
Pichler, R:
Med Univ Innsbruck, Comprehens Canc Ctr Innsbruck, Dept Urol, A-6020 Innsbruck, Austria
Stäblein, J:
Med Univ Innsbruck, Comprehens Canc Ctr Innsbruck, Dept Urol, A-6020 Innsbruck, Austria
Mari, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
Afferi, L:
Luzerner Kantonsspital, Dept Urol, CH-6000 Luzern, Switzerland
D'Andrea, D:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, A-1090 Vienna, Austria
Marcq, G:
CHU Lille, Claude Huriez Hosp, Dept Urol, F-59000 Lille, France
del Giudice, F:
Sapienza Univ Rome, Policlin Umberto I Hosp, Dept Maternal Infant & Urol Sci, I-00185 Rome, Italy
Soria, F:
Univ Studies Torino, Div Urol, Dept Surg Sci, I-10126 Turin, Italy
Caño-Velasco, J:
Gregorio Maranon Univ Hosp, Dept Urol, Madrid 28007, Spain
Subiela, JD:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Urol, IRYCIS, Madrid 28034, Spain
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona 08193, Spain
Tully, KH:
Ruhr Univ Bochum, Marien Hosp Herne, Dept Urol & Neurourol, D-44625 Herne, Germany
Mori, K:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, A-1090 Vienna, Austria
Jikei Univ, Sch Med, Dept Urol, Tokyo 1058461, Japan
Herms, A:
Med Univ Innsbruck, Dept Neurol, Neurourol Unit, A-6020 Innsbruck, Austria
Pradere, B:
La Croix du Sud Hosp, Dept Urol, F-31130 Quint Fonsegrives, France
Moschini, M:
Univ Vita Salute San Raffaele, IRCCS Osped San Raffaele, Dept Urol, I-20132 Milan, Italy
Mertens, LS:
Antoni Van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, NL-1066 CX Amsterdam, Netherlands
Thurnher, M:
Med Univ Innsbruck, Dept Urol, Immunotherapy Unit, A-6020 Innsbruck, Austria
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