Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disorder characterized by bladder pain upon filling which severely affects quality of life. Clinical presentation can vary. Local inflammatory events typify the clinical presentation of IC/BPS patients with Hunner lesions (IC/BPS-HL). It has previously been proposed that B cells are more prevalent in HL, but understanding their exact role in this environment requires a more complete immunological profile of HL. We characterized immunological dysfunction specifically in HL using immunohistochemistry. We detected significantly more plasma cells (50× increase, p < 0.0001), B cells (28× increase, p < 0.0001), T cells (3× increase, p < 0.0001), monocytes/macrophages (6× increase, p < 0.0001), granulocytes (4× increase, p < 0.0001), and natural killer cells (2× increase, p = 0.0249) in IC/BPS patients with HL than in unaffected controls (UC). Patients with IC/BPS-HL also had significantly elevated urinary levels of IL-6 (p = 0.0054), TNF-α (p = 0.0064) and IL-13 (p = 0.0304) compared to patients with IC/BPS without HL (IC/BPS-NHL). In contrast, IL-12p70 levels were significantly lower in the patients with HL than in those without these lesions (p = 0.0422). Different cytokines were elevated in the urine of IC/BPS patients with and without HL, indicating that different disease processes are active in IC/BPS patients with and without HL. Elevated levels of CD138+, CD20+, and CD3+ cells in HL are consistent B and T-cell involvement in disease processes within HL.
Highlights
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) affects millions of individuals within the US [1]
Biopsy samples from 2 patients who presented with benign bladder tumors and no morphologic or clinical features of IC/BPS or any other urological malignancy were retrieved to serve as unaffected controls (UC)
Urine samples were obtained from 18 patients with IC/ BPS-Hunner lesions (HL), 18 with IC/BPS-NHL and 4 UC
Summary
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) affects millions of individuals within the US [1]. It is defined by bladder pain/discomfort accompanied by irritative voiding symptoms in the absence of other identifiable etiologies. While most patients with IC/BPS show no cystoscopic abnormalities of the bladder wall (IC/BPSNHL), a small percentage of patients with IC/BPS present with focal regions of gross bladder inflammation termed Hunner lesions (HL). These lesions are typically associated with small vessels radiating toward a central scar and a fibrinous exudate (Fig. 1) [4]. Determining which cytokines and immunological pathways are present in Moldwin et al Journal of Translational Medicine (2022) 20:97
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