New Frontiers or the Treatment of Interstitial Cystitis/Bladder Pain Syndrome - Focused on Stem Cells, Platelet-Rich Plasma, and Low-Energy Shock Wave

Abstract

Interstitial cystitis/bladder pain syndrome (IC/BPS), which is characterized by bladder pain and irritative voiding symptoms, is a frustrating disease without effective treatment. The cause is still largely not understood, although urothelium ischemia/hypoxia, apoptosis, denudation, and infiltration of inflammatory cells are common histopathological findings. The current uncertainty regarding the etiology and pathology of IC/BPS has a negative impact on its timely and successful treatment; therefore, the development of new treatment modalities is urgently needed. Herein, we present advances in our knowledge on this topic and review the potential application of regenerative medicine for the treatment of IC/BPS. This article provides information on the basic characteristics and clinical evidence of stem cells, platelet-rich plasma (PRP), and low-energy shock waves (LESWs) based on a literature review with a search strategy for articles related to IC/BPS, stem cells, PRP, and LESW published in MEDLINE and PubMed. Stem cells, PRP, and LESW, which modulate inflammatory processes and promote tissue repair, have been proven to improve bladder regeneration, relieve bladder pain, inhibit bladder inflammation, and increase bladder capacity in some preclinical studies. However, clinical studies are still in their infancy. Based on the mechanisms of action of stem cells, PRP, and LESW documented in many preclinical studies, the potential applications of regenerative medicine for the treatment of IC/BPS is an emerging frontier of interest. However, solid evidence from clinical studies remains to be obtained.

Improves symptoms and urinary biomarkers in refractory interstitial cystitis/bladder pain syndrome patients randomized to extracorporeal shock wave therapy versus placebo

“…Low energy shock wave (LESW), known to exert anti-inflammatory, anti- apoptotic effects, and improve tissue repair, has been applied for the treatment of urological disease, including erectile dysfunction, and chronic prostatitis chronic pelvic pain syndrome 5 , 6 . Furthermore, recent publications have been extended into the field of bladder dysfunction and demonstrated therapeutic effects of LESW on overactive bladder and IC/BPS 7 , 8 .…”

Improves Symptoms and Urinary Biomarkers in Refractory Interstitial Cystitis/Bladder Pain Syndrome Patients Randomized to Extracorporeal Shock Wave Therapy Versus Placebo

“…Low energy shock wave (LESW), known to exert anti-in ammatory, anti-apoptotic effects, and improve tissue repair, has been applied for the treatment of urological disease, including erectile dysfunction, and chronic prostatitis chronic pelvic pain syndrome. 5,6 Furthermore, recent publications have been extended into the eld of bladder dysfunction and demonstrated therapeutic effects of LESW on overactive bladder and IC/BPS. 7,8 The approaches used for mechanistic studies on e cacy of LESW in animal model 6,9 need to be modi ed for human con rmation .…”

“…5,6 Furthermore, recent publications have been extended into the eld of bladder dysfunction and demonstrated therapeutic effects of LESW on overactive bladder and IC/BPS. 7,8 The approaches used for mechanistic studies on e cacy of LESW in animal model 6,9 need to be modi ed for human con rmation . Towards that end we assessed the change in urine levels of multiple growth factors, cytokines, chemokines, and clinical symptoms of IC/BPS patients at baseline and after LESW or placebo treatment.…”

Reply to the Commentary on “New Frontiers or the Treatment of Interstitial Cystitis/Bladder Pain Syndrome-Focused on Stem Cells, Platelet-Rich Plasma, and Low-Energy Shock Wave”

“…The therapeutic effects of MSCs mediated partly through the paracrine release of various bioactive factors [ 1 ]. Some of the therapeutic effects are mediated by MSCs-derived extracellular vesicles (EVs), a generic term for a heterogeneous group of cellreleased membranous structures comprising endosome-origin “exosomes” and plasma membrane-derived “microvesicles” (microparticles/ectosomes) [ 2 ].…”