Abstract
AimsTo investigate urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels in interstitial cystitis/bladder pain syndrome (IC/BPS) patients after hyaluronic acid (HA) therapy.MethodsThirty-three patients with IC/BPS were prospectively studied; a group of 45 age-matched healthy subjects served as controls. All IC/BPS patients received nine intravesical HA instillations during the 6-month treatment regimen. Urine samples were collected for measuring urinary NGF and BDNF levels at baseline and 2 weeks after the last HA treatment. The clinical parameters including visual analog scale (VAS) of pain, daily frequency nocturia episodes, functional bladder capacity (FBC) and global response assessment (GRA) were recorded. Urinary NGF and BDNF levels were compared between IC/BPS patients and controls at baseline and after HA treatment.ResultsUrinary NGF, NGF/Cr, BDNF, and BDNF/Cr levels were significantly higher in IC/BPS patients compared to controls. Both NGF and NGF/Cr levels significantly decreased after HA treatment. Urinary NGF and NGF/Cr levels significantly decreased in the responders with a VAS pain reduction by 2 (both p < 0.05) and the GRA improved by 2 (both p < 0.05), but not in non-responders. Urinary BDNF and BDNF/Cr did not decrease in responders or non-responders after HA therapy.ConclusionsUrinary NGF, but not BDNF, levels decreased significantly after HA therapy; both of these factors remained higher than in controls even after HA treatment. HA had a beneficial effect on IC/BPS, but it was limited. The reduction of urinary NGF levels was significant in responders, with a reduction of pain and improved GRA.
Highlights
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory disorder of the urinary bladder characterized by bladder pain associated with frequency, urgency, nocturia, and sterile urine
Both nerve growth factor (NGF) and NGF/Cr levels significantly decreased after hyaluronic acid (HA) treatment
Urinary NGF and NGF/Cr levels significantly decreased in the responders with a visual analog scale (VAS) pain reduction by 2 and the global response assessment (GRA) improved by 2, but not in non-responders
Summary
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory disorder of the urinary bladder characterized by bladder pain associated with frequency, urgency, nocturia, and sterile urine. The aetiology of IC/BPS remains unclear and is thought to be multifactorial, including defective or dysfunctional bladder urothelium, neurogenic inflammation, activation of mast cells, autoimmunity, and occult infection [1,2,3]. Suburothelial and neurogenic inflammation in IC/BPS inhibits normal basal cell proliferation and affects apical urothelial function, forming a vicious cycle provoking and maintaining inflammatory reactions in the bladder [1,5]. A few uncontrolled or noninterventional studies of intravesical HA treatment of IC/BPS patients showed symptomatic improvement over a broad range between 30% and 85% of patients [10,11,12,13,14,15,16]. These studies lacked solid evidence from multi-centre, randomized controlled trials to show the long-term superiority and the anti-inflammatory effect of intravesical HA treatment for IC/ BPS
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