Intravesical drug delivery for dysfunctional bladder

Abstract

The bladder is a hollow organ that can be treated locally by transurethral catheter for intravesical drug instillation or cystoscopy for intravesical drug injection. With advancing technology, local organ-specific therapy and drug delivery is of expanding interest for treating dysfunctional bladder, including interstitial cystitis/bladder pain syndrome, overactive bladder and sterile hemorrhagic cystitis after chemotherapy or pelvic radiation. Intravesical therapy has shown varying degrees of efficacy and safety in treating interstitial cystitis/bladder pain syndrome, overactive bladder and hemorrhagic cystitis with new modalities being developed. Intravesical (regional) therapy has several advantages than oral (systemic) therapy, including high local concentration and less systemic toxicity. In recent years, intravesical delivery of biotechnological products including neurotoxins and immunosuppressive agents, and delivery platform including liposomes has shown promise for lower urinary tract symptoms. This review considers the current status of intravesical therapy in dysfunctional bladder including interstitial cystitis/bladder pain syndrome, overactive bladder and hemorrhagic cystitis with special attention to lipid based novel drug-delivery.

Bladder Instillation of Liposome Encapsulated OnabotulinumtoxinA Improves Overactive Bladder Symptoms: A Prospective, Multicenter, Double-Blind, Randomized Trial

“…20 They can incorporate various sizes of drug molecules, hydrophilic and hydrophobic, and even plasmids, and show greater uptake into cells through endocytosis. 21 Intravesical empty liposomes have therapeutic benefits in patients with interstitial cystitis/bladder pain syndrome which may be attributed to liposomes coating the bladder urothelium that may improve epithelial healing and barrier function. 22 Lipo-BoNT has been shown to split the SNAP-25 in the bladder urothelium.…”

Intravesical Electromotive Botulinum Toxin in Women with Overactive Bladder – A Pilot Study

“…Some instillation methods employ a carrier substance to improve treatment effect by prolonging contact with the bladder mucosa [18] . Lately, liposomes acting as drug carriers have come under study for OAB [23] .…”

Single compartment drug delivery

“…Liposomal formulations have the potential to increase drug solubility and stability in urine while also increasing cellular uptake through endocytosis [47, 48, 50]. Empty liposomes have been shown to have a therapeutic effect on IC/PBS patients in several clinical trials, possibly by forming a protective lipid layer on the urothelial surface [56–58].…”