Interstitial Cystitis/painful bladder syndrome (PBS) is a debilitating condition has historically been difficult to diagnose. The exact cause is unknown however, systemic neurosensitization and neuroinflammation that occurs within the bladder and also some other organ systems has been implicated. IC/PBS, as defined by 2009 new American IC/BPS Guidelines is “an unpleasant sensation (pain/discomfort) perceived to be urinary bladder related of more than 6 weeks duration, associated with lower urinary tract symptoms, but absent infection or other identifiable causes.”. A biomarker, antiproliferative factor (APF) which inhibits bladder cell proliferation, may be found in the urine of IC/PBS patients. APF makes bladder lining healing more difficult (1). The end result of IC is damage to urothelium and bladder muscle that can run the spectrum from mild/PBS is mucosal irritation which may progress to deep Hunner’s ulcers.
INTERSTITIAL CYSTITIS AND ADIPOSE DERIVED MESENCHYMAL STEM CELLS
Adipose derived adult (non-embryonic) mesenchymal stem cells have the ability to seek out areas of injury and via a process of regeneration assist in the repair of nerves, blood vessels, muscle, fat, cartilage, bone, and many other structures. Cytokines (SDF-1 stromal derived factor one, HGF hepatocyte growth factor, and platelets), recruit stem cells to sites of inflammation, ischemia, hypoxia, or injury. There they participate in healing by directly forming needed cells or secreting growth factors that promote healing by other cell types. Stem cells are mobilized naturally and are available in human adipose tissue. Adipose derived stem cells are abundant in levels up to 2500 times greater than those found in bone marrow. Evidence suggests that adipose derived stem cells can differentiate into functional smooth muscle cells. Bladder repair by stem cells may therefore be possible in IC/PBS patients. An animal study of bladder outlet obstruction demonstrated that mesenchymal stem cells (MSC’s) injected intravenously improved bladder compliance. Another animal model study using intravesical instillation of adipose derived stem cells demonstrated evidence of smooth muscle incorporation into the bladder wall. We believe that stem cell treatment may be helpful for IC/PBS patients exhibiting mucosal and smooth muscular damage. Our IC/PBS protocol uses high doses of stem cells injected intravenously and also intra-vesically (directly into the bladder lumen) and in some cases directly into the pelvic floor.
OC Regenerative Medicine uses high dose autologous adipose derived stem cells for the investigational treatment of various diseases. Autologous means that patients only receive cells from only their own bodies. Only adult adipose derived stem cells are used at the OC Regenerative Medicine since embryonic stem cells have the potential to form rare tumors and have ethical considerations. State of the art equipment is used to isolate the adipose derived stem cells. We participate in a pilot study investigating the use of adipose derived stem cells for interstitial cystitis that is patient funded. A “mini” liposuction-like procedure performed under local anesthetic to obtain the stem cells. Stem cell isolation and deployment is carried out in our facility within three hours. Regenerative healing occurs over time naturally and immediate improvement symptom improvement is not expected. Patients will be followed closely through our research registry and data collected carefully to help establish effectiveness of our treatment protocols.