Effect of diagnostic hydrodistension and four intravesical hyaluronic acid instillations on bladder ICAM-1 intensity and association of ICAM-1 intensity with clinical response in patients with interstitial cystitis.
OBJECTIVE
To study the clinical effect of diagnostic overdistension plus hyaluronic acid (HA) instillations in interstitial cystitis and the association of the clinical response with the intensity of intercellular adhesion molecule (ICAM)-1 expression. HA is an important component in the urothelium. It inhibits adherence of immune complexes to polymorphonuclear cells, leukocyte migration, and aggregation. HA binds to lymphocytes and endothelial cells expressing ICAM-1.


METHODS
Eleven patients with interstitial cystitis who fulfilled the diagnostic criteria of the National Institutes of Health were selected for the trial. The bladder was distended for 1 minute with a pressure of 80 cm H2O and biopsies were taken from the petechial areas. The patients were treated with four weekly intravesical HA instillations (40 mg/50 mL NaCl solution). Biopsies were repeated 2 weeks after the instillations. The ICAM-1 intensity was blindly determined in the lymphocytes and endothelial cells of the vessels from the histologic biopsies. A semiquantitative scoring index was used to measure the inflammatory effect of ICAM-1 receptors.


RESULTS
In the long-term responders (2 women and 1 man) and short-term responders (5 women), the pretreatment ICAM-1 index was 3.7 (range 3 to 4); it was 1.8 (range 1.5 to 2) in the nonresponders. Two weeks after the final instillation, the index was 3.5 (range 3 to 4) in the long-term responders and 3.4 (range 3 to 4) in the short-term responders; in the nonresponders, it had increased to 2.8 (range 2.5 to 3.5).


CONCLUSIONS
Increased ICAM-1 intensity was found in patients with interstitial cystitis; it was higher in those who responded to overdistension plus HA instillations. By blocking the ICAM-1 receptors, HA presumably alleviates the inflammatory processes, but repeated instillations are needed to maintain the response.
Leppilahti
Mikael
M
Division of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland.
Hellström
Pekka
P
Tammela
Teuvo L J
TL
D000283:Administration, Intravesical; D000368:Aged; D001706:Biopsy; D018856:Cystitis, Interstitial / Q000188:drug therapy / Q000628:therapy*; D004106:Dilatation / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis*; D008214:Lymphocytes / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000737:chemistry / Q000502:physiology*; D019459:Urothelium / Q000737:chemistry / Q000166:cytology
D018799:Intercellular Adhesion Molecule-1; D006820:Hyaluronic Acid