Chondroitin sulfate GAG-replenishment therapy and its effect on
restoring the barrier function of urothelium in an experimental model
for BPS/IC.
Abstract
Background and Purpose Bladder pain syndrome/interstitial cystitis
(BPS/IC) has been clinically treated with glycosaminoglycan (GAG)
replenishment therapy. [1, 2] This study was designed to further
understand the physiological mechanism behind chondroitin sulfate (CS)
treatment and to determine the effect of CS-therapy on recovery of
urothelial barrier in an in-vitro chronic injury model. Experimental
Approach In differentiated porcine urothelial cells the functional
barrier was measured by transepithelial electrical resistance (TEER). A
chronic urothelium was inflicted by multiple protamine instillations
(3/day for 3 days), to approximate BPS/IC urothelium conditions. CS was
instilled afterwards. Recovery of barrier function was followed in time.
Additional analyses were performed for immunohistochemistry for barrier
markers (tight junctions, GAG’s, umbrella cells) and scanning electron
microscopy. Statistics were described by means ± standard error, α =
0.05. Key Results Barrier recovery (TEER) improved significantly with CS
instillations compared to protamine only (T=7, 899.1 [Ω.cm2] versus
589.6 [Ω.cm2], p<0.001, 95% CI -394;-255). This recovery
effect was seen on all three days and resulted in a significantly higher
average TEER value in the CS group after 3 days (2606 Ω.cm2 vs 750.5
Ω.cm2). Immunohistochemistry and scanning electron microscopy showed
decreased barrier markers after protamine treatment and enhanced
recovery of urothelial GAG’s and other barrier markers after therapeutic
instillations. Conclusion and Implications GAG replenishment with CS can
improve recovery of barrier function of chronically damaged urothelium
in-vitro. This preclinical study supports the hypothesis behind the use
of clinical GAG replenishment therapy for patients with a chronically
impaired urothelium.