PAINFUL BLADDER SYNDROME
Millions of patients experience the ill effects of Interstitial Cystitis /painful bladder syndrome. This intense and incapacitating condition has historically been confused with other bladder pathology which must be ruled out, making IC challenging to diagnose. Presently, Interstitial Cystitis/PBS is characterized as “an unpleasant sensation (pain, pressure, discomfort) perceived to be identified with the urinary bladder, connected with lower urinary tract symptoms of more than 6 weeks span, without infection or other identifiable reasons.” (2009 new American IC/BPS Guidelines). Although there are some theories to clarify IC, the exact cause remains unclear. Numerous patients with IC have the biomarker APF (antiproliferative factor) in their urine which restrains bladder cell proliferation, making healing of the bladder lining much more challenging (1). Recent research demonstrates IC may be identified with systemic neurosensitization and neuroinflammation that happens inside the bladder and some other organ systems (2). Despite the cause, the end result of IC is damage to urothelium and bladder muscle that can run the spectrum from mild mucosal irritation to deep Hunner’s ulcers.
INTERSTITIAL CYSTITIS AND ADIPOSE DERIVED MESENCHYMAL STEM CELLS
Adipose derived adult (non-embryonic) mesenchymal stem cells are at present being examined for utilization in degenerative conditions that results in harm to different organs and systems. These cells can seek out areas of injury and regeneration and aid in the repair of nerves, veins, muscle, fat, cartilage, bone, and numerous different structures. These cells are regularly recruited by cytokines (SDF-1 stromal derived factor one, HGF hepatocyte growth factor, and platelets), to sites of inflammation, ischemia, hypoxia, or injury and they assist in the healing process either by specifically structuring needed cells or emitting chemical messengers that promote healing. Stem cells are activated regularly from bone marrow when the body is healing yet they are additionally discovered dormant however accessible in human adipose tissue. These stem cells from fat are abundant in levels up to 2500 times more than those discovered in bone marrow and research demonstrates that the fat derived stem cells have equal regeneration potential to the bone marrow units. Also, stem cell treatment success seems to identify with the amount of cells utilized and this gives adipose cells a significant potential advantage to regenerate human tissues. Mesenchymal stem cells have been utilized extensively around the world in the successful treatment of orthopedic, cardiovascular, pulmonary, and neurologic disease in both people and veterinary models. We have confirmation that adipose derived stem cells can separate into functional smooth muscle cells and we think therefore, that bladder repair by stem cells may be conceivable in IC patients. A recent study in mice with bladder outlet obstruction exhibited that florescent protein labeled MSC’s (mesenchymal stem cells) injected intravenously into test subjects incorporated into bladder muscle bringing about diminished hypoxia, hypertrophy, and fibrosis and increased blood flow. The vast majority of mice who received MSC’s had enhanced bladder compliance.
We realize that patients with IC show abnormal cell signaling and cytokine release. For this reason, we accept that stem cell treatment may be supportive for interstitial cystitis patients who show mucosal and smooth muscular damage. We have developed a protocol to treat patients with IC of different stages with adipose derived stem cells. Our protocol utilizes high measurements of stem cells injected intravenously and likewise intra-vesically (directly into the bladder lumen) and in a few cases directly into trigger points in the pelvic floor. We have proof that intravesical instillation of adipose derived stem cells into mice successfully demonstrates morphological and phenotypic evidence of smooth muscle incorporation into the bladder wall three months after instillation.
Regenerative Medicine Institute of Nevada is utilizing high dose autologous adipose derived stem cells for the investigational treatment of different degenerative diseases. The utilization of autologous cells guarantees that the patients get cells from just their own body. The technology to isolate the adipose derived stem cells has been obtained from Korea and is state of the art. All studies are patient financed and not approved by the FDA. We have started a pilot study to examine the viability of high dosage adipose derived stem cells on interstitial cystitis.Only adult adipose derived stem cells are utilized at the Regenerative Medicine Institute of Nevada since embryonic stem cells have the possibility to form rare tumors and have moral contemplations. At Regenerative Medicine Institute of Nevada, the stem cells are acquired from a “small” liposuction-like procedure performed under local anesthetic. Stem cells are isolated on site from the patient’s own particular fat and then deployed in our office inside 180 minutes. Regenerative recuperation naturally takes time and we do not expect immediate improvement in symptoms. Patients will be followed closely through our research registry and data collected carefully to help build viability of our treatment protocols.