Treating BCG-Induced Cystitis with Combined Chondroitin and Hyaluronic Acid Instillations in Bladder Cancer

In non-muscle invasive bladder cancer, Bacillus Calmette-Guérin (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...

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Detalles Bibliográficos
Autores: Pichler, Renate|||0000-0001-5286-9048, Stäblein, Johannes, Mari, Andrea|||0000-0001-9070-5706, Afferi, Luca|||0000-0002-5472-1933, D'Andrea, David|||0000-0003-1625-1077, Marcq, Gautier|||0000-0002-1806-1448, Del Giudice, Francesco|||0000-0003-3865-5988, Soria, Francesco|||0000-0001-8443-8453, Caño-Velasco, Jorge, Subiela, José Daniel|||0000-0003-4176-8174, Gallioli, Andrea|||0000-0002-3316-5691, Tully, Karl Heinrich|||0000-0002-9499-0169, Mori, Keiichiro|||0000-0002-6147-6569, Herms, Achim, Pradere, Benjamin|||0000-0002-7768-8558, Moschini, Marco|||0000-0002-3084-2458, Mertens, Laura S.|||0000-0003-3317-6427, Thurnher, Martin|||0000-0001-9940-7326
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:306323
Acceso en línea:https://ddd.uab.cat/record/306323
https://dx.doi.org/urn:doi:10.3390/jcm13072031
Access Level:acceso abierto
Palabra clave:BCG
Bladder cancer
Chondroitin
Cystitis
Hyaluronic acid
Intravesical instillations
Descripción
Sumario:In non-muscle invasive bladder cancer, Bacillus Calmette-Guérin (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.

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