The Enigma of Interstitial Cystitis—an Autoimmune Disease?

Abstract

Interstitial cystitis (IC) is characterised by recurrent inflammation and destruction of bladder tissue without obvious cause. To determine whether this self-perpetuating disease is the result of an autoimmune disorder, we studied 26 patients with IC of mean duration 5 years and compared the results with those of a control group of similar age and sex with other urological complaints. We performed a standard autoimmune profile and looked for specific antibodies to normal human bladder in the serum, using an indirect immunofluorescence technique. Deep bladder biopsies were examined by conventional histology and cryostat sections were studied with peroxidase-conjugated anti-human antibodies in a search for immunoglobulin deposition within the bladder. Seventeen of 26 patients with IC (65%) and 5 of 14 controls (36%) demonstrated non-organ-specific antibodies; 40% of those with IC had anti-nuclear antibodies; 18 IC patients (75%) and 4 of 10 controls (40%) had anti-bladder antibodies present in the serum, but 5 healthy volunteers showed no such antibody activity. There was no statistically significant difference between the two groups for either type of antibody (Fisher's exact test). Only 5 of 17 patients with IC (29%) showed immunoglobulin deposition in the bladder epithelium, a similar proportion to controls (38%); 4 of these 5 had circulating anti-bladder antibodies present in the serum. Although IC patients demonstrated a non-specific increase in antibody formation, this was not significantly different from a similar group of other urological patients. The lack of specificity makes this immunological response more likely to be a secondary phenomenon associated with inflammatory damage to the bladder rather than the primary cause of the disease.

Abnormal urothelial HLA-DR expression in interstitial cystitis

“…It has been suggested thai interstitial cystitis might be an autoimmune disease [2] since circulating antibladder antibodies have been demonstrated in some ca,ses of inlerstitia! cystitis [4][5][6]. although others have failed to confirm these findings [7j,…”

“…UK. cystitis [1.2.41, and a large numberof IgG, IgA and IgM positive plasma cells have been identihed wilhin the submucosa of the affected tissue in interstitial cystitis [6,8]. In addition.…”

RDP58 inhibits T cell-mediated bladder inflammation in an autoimmune cystitis model

“…For instance, interstitial cystitis (IC) is a chronic inflammatory condition of the bladder with a strong autoimmune component while the etiology of IC remains to be elucidated [7][8][9]. Antinuclear IgG and anti-epithelial cell autoantibodies have been found in the majority of IC patients [10][11][12][13][14]. Abnormal urothelial HLA-DR expression has also been reported in IC patients [15,16].…”

Polysaccharide Capsule and Sialic Acid-Mediated Regulation Promote Biofilm-Like Intracellular Bacterial Communities during Cystitis

“…Bacteria embedded in the IBC have cell-associated appendages such as type 1 pili and antigen 43 (3). The matrix also stains by periodic acid Schiff, suggesting the presence of polysaccharides (3). However, the specific type of polysaccharide present in the IBC matrix is not known.…”