Effect of diagnostic hydrodistension and four intravesical hyaluronic acid instillations on bladder ICAM-1 intensity and association of ICAM-1 intensity with clinical response in patients with interstitial cystitis

• Published in: Urology (Ridgewood, N.J.) Vol. 60; no. 1; pp. 46 - 51
• Main Authors: Leppilahti, Mikael, Hellström, Pekka, Tammela, Teuvo L.J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2002; Elsevier Science
• Subjects: Administration, Intravesical; Aged; Biological and medical sciences; Biopsy; Cystitis, Interstitial - drug therapy; Cystitis, Interstitial - therapy; Dilatation - methods; Drug Administration Schedule; Female; Humans; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - therapeutic use; Immunopathology; Immunotherapy (general aspects); Intercellular Adhesion Molecule-1 - analysis; Lymphocytes - chemistry; Male; Medical sciences; Middle Aged; Treatment Outcome; Urinary Bladder - chemistry; Urinary Bladder - physiology; Urothelium - chemistry; Urothelium - cytology; Human; Urinary system disease; Intercellular adhesion molecule 1; Exploration; Histology; Pathology; Treatment; Urinary bladder; Immunotherapy; Bladder disease; Interstitial; Intravesical administration; Hyaluronic acid; Cystitis
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(02)01613-8

Objectives. To study the clinical effect of diagnostic overdistension plus hyaluronic acid (HA) instillations in interstitial cystitis and the association of the clinical response with the intensity of intercellular adhesion molecule (ICAM)-1 expression. HA is an important component in the urothelium. It inhibits adherence of immune complexes to polymorphonuclear cells, leukocyte migration, and aggregation. HA binds to lymphocytes and endothelial cells expressing ICAM-1. Methods. Eleven patients with interstitial cystitis who fulfilled the diagnostic criteria of the National Institutes of Health were selected for the trial. The bladder was distended for 1 minute with a pressure of 80 cm H 2O and biopsies were taken from the petechial areas. The patients were treated with four weekly intravesical HA instillations (40 mg/50 mL NaCl solution). Biopsies were repeated 2 weeks after the instillations. The ICAM-1 intensity was blindly determined in the lymphocytes and endothelial cells of the vessels from the histologic biopsies. A semiquantitative scoring index was used to measure the inflammatory effect of ICAM-1 receptors. Results. In the long-term responders (2 women and 1 man) and short-term responders (5 women), the pretreatment ICAM-1 index was 3.7 (range 3 to 4); it was 1.8 (range 1.5 to 2) in the nonresponders. Two weeks after the final instillation, the index was 3.5 (range 3 to 4) in the long-term responders and 3.4 (range 3 to 4) in the short-term responders; in the nonresponders, it had increased to 2.8 (range 2.5 to 3.5). Conclusions. Increased ICAM-1 intensity was found in patients with interstitial cystitis; it was higher in those who responded to overdistension plus HA instillations. By blocking the ICAM-1 receptors, HA presumably alleviates the inflammatory processes, but repeated instillations are needed to maintain the response.