PDF(Pubmed)
Abstract：
In non-muscle invasive bladder cancer, Bacillus Calmette-Guérin (BCG) responders benefit from strong Th1-type inflammatory and T cell responses mediating tumor rejection. However, the corresponding lack of anti-inflammatory Th2-type immunity impairs tissue repair in the bladder wall and facilitates the development of cystitis, causing urinary pain, urgency, incontinence, and frequency. Mechanistically, the leakage of the glycosaminoglycan (GAG) layer enables an influx of potassium ions, bacteria, and urine solutes towards the underlying bladder tissue, promoting chronic inflammation. Treatments directed towards re-establishing this mucopolysaccharide-based protective barrier are urgently needed. We discuss the pathomechanisms, as well as the therapeutic rationale of how chondroitin and hyaluronic acid instillations can reduce or prevent BCG-induced irritative bladder symptoms. Moreover, we present a case series of five patients with refractory BCG-induced cystitis successfully treated with combined chondroitin and hyaluronic acid instillations.
摘要：
在非肌肉浸润性膀胱癌中，卡介苗(BCG)应答者受益于介导肿瘤排斥的强Th1型炎症和T细胞应答。然而,相应的抗炎Th2型免疫的缺乏会损害膀胱壁的组织修复，并促进膀胱炎的发展，引起尿痛,紧迫性,失禁,和频率。机械上,糖胺聚糖（GAG）层的泄漏使钾离子流入，细菌,和尿液溶质流向下面的膀胱组织，促进慢性炎症。迫切需要针对重建这种基于粘多糖的保护性屏障的治疗。我们讨论病理机制，以及软骨素和透明质酸滴注如何减少或预防卡介苗引起的刺激性膀胱症状的治疗原理。此外，我们介绍了5例卡介苗诱导的难治性膀胱炎患者，这些患者采用软骨素和透明质酸滴注联合治疗。
