Interstitial cystitis: Aetiology and therapeutic potential of honey

Abstract

Painful bladder syndrome/interstitial cystitis (PBS/IC) is an under-researched urological disorder, and thus, is poorly understood, diagnosed, and managed. This project was designed to elucidate the role of mast cells (MCs) and basophils in PBS/IC, identify any difference in the distribution of MC subtypes (MC_T and MC_TC), and assess the potential of honey as a treatment for PBS/IC.

The study was successful in that it identified a difference in the distribution of MCs within the bladder wall, and a difference in distribution of MC subtypes, in comparison to controls. Novel findings from this study included the discovery that a particularly high presence of MC_TC in the mucosa may be linked to the presence of ulcers, and thus, identified the patients that may have had the Hunner’s Ulcer PBS/IC subtype. It was also found that some patients had a higher amount of MC_TC in the lamina propria (p<0.001), and this may identify those patients that were also suffering from fibrotic bladder. Immunohistochemistry findings confirmed detrusor mastocytosis in PBS/IC bladder (p<0.001), compared to controls. Basophils were not found in PBS/IC bladder tissues. It was also discovered that honey does not bind histamine, and so is stabilising MCs at a molecular level. Histamine release was decreased in explants that had been incubated in 5% or 10% honey, and tissues showed signs of apoptosis in concentrations above 20%.

After further validation, findings could be used to develop much-needed comprehensive diagnostic criteria for the successful identification of different subgroups of PBS/IC sufferers, and for the development of tailored therapeutic options, that would consequently be more effective for the patient. The development of a honey-based intravesical agent, that has the potential to treat the histamine-related inflammation seen in PBS/IC, and other difficult to treat inflammatory disorders, is a promising and exciting future direction for this study.

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Identifiers

ORCID for David Voegeli: orcid.org/0000-0003-3457-7177

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