Epidemiology and treatment of interstitial cystitis/painful bladder syndrome and the potential of medical grade manuka honey as therapeutic strategy

Abstract

Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) is a complex urological disease with no known cure yet. There are over 180 available treatment options, the effectiveness of which are variable. Scarce data exist regarding perception of treatments and Health Related Quality of Life (HRQoL) in this patient population. Herein, an epidemiologic description of the treatments used in IC/PBS and the relationship between illness perception and severity of symptoms was undertaken using an online questionnaire completed by members of the Bladder Health UK (BHUK). The O’Leary/Sant, Pelvic Urgency and Frequency (PUF), Brief Illness Perception and King Health questionnaires were used to collect data from study participants. A key finding of this work shows that irrespective of background treatments, many patients remain symptomatic with a mean ± SD O’Leary/Sant scores of 20.12 ± 9.38. Many participants were not on oral treatment. There were no significant differences between the O’Leary/Sant scores of cohorts currently taking oral medications and those who remain untreated (p=0.234). Amitriptyline was the most common medication used either alone or in combination for the treatment of the disease in the cohort. In terms of lifestyle changes, the O’Leary/Sant scores of those drinking alcohol were significantly lower than those not drinking (p≤0.05). There was marked deterioration of HRQoL of the respondents as evaluated by KHQ and BIP-Q. About 25% of the sample believed that IC/PBS had negative consequences for their daily lives while more than 75% could see no end to their symptoms. Most of the participants indicated that their disease made them worry and become emotionally unstable with a resultant decrease in quality of life. The BIP-Q items that were associated with IC/PBS severity were (Adjusted Odd Ratio (AOR) and Confidence Interval (CI)): Consequence 0.09 (0.02- 0.38); Treatment control 2.702 (1.25-5.81); Identity 0.141 (0.03-0.60) and Concern 9.36 (1.52- 57.63). Overall, this survey identified that over 80% of the participants were still symptomatic despite many being on no specific oral therapy. Participants were using non-guideline recommended treatments such as gabapentenoids, antibiotics, smooth muscle relaxants, and herbal formulae amongst others. This suggests a need to test the hypotheses as to whether such non-guideline treatments could be useful in IC/PBS using appropriately designed experimental studies. Accordingly, the cell culture work was aimed at demonstrating the potentials of medical grade Manuka honey (MH) on IC/PBS cellular model. This was done using β-hexosaminidase release assay, histamine ELISA and SDS PAGE. MH was tolerable at 2% and 4% and significantly inhibited release of beta hexosaminidase in SP, IgE and A23187 models p≤0.001, p=0.000 and p≤0.001 respectively. It also inhibited the release of histamine (p≤0.05). Likewise, MH at 4% also inhibited the release of IL-8 (p≤0.001) and GM-CSF (p=0.000) following A23187 stimulation and IL-8 (p≤0.001) and GM-CSF (p=0.000) after being challenged by Substance P (SP). Furthermore, MH attenuates the expression of Akt (p≤0.05), p38 (p≤0.05) and ERKI (p≤0.05) in SP challenged LAD2 cells. Similarly, MH suppressed the expression of ERK I and ERK II (p=0.000) in A23187 and IgE stimulated LAD2 cells. These results suggest that MH could be a novel candidate agent for the treatment for IC/PBS.

More information

Identifiers

ORCID for Bashir Lwaleed: orcid.org/0000-0001-5748-4892

Catalogue record

Export record