Oct. 20, 1997 Nearly half a million women in the United States suffer from interstitial cystitis (IC), a chronic bladder disorder for which there is no cure and whose diagnosis involves a process so painful it can require general anesthesia. Dr. Susan Keay, associate professor at the University of Maryland School of Medicine, has identified two factors that could lead to a better understanding of the disease, as well as less painful methods of diagnosis and more effective treatment.
Keay’s first discovery, presented at the recent meeting of the American Urogynecologic Society, determined that an antiproliferative peptide specifically present in the urine of IC patients inhibits bladder epithelial cell proliferation and regeneration. Based on this finding, she and her colleagues hypothesized that IC may result from impaired of regeneration these cells. Parts of the bladder wall that are void of epithelial cells are more prone to inflammation and disease. The presence of this antiproliferative peptide in the urine of IC patients suggests that a simple test for the presence of this peptide could significantly reduce the need for cystoscopy and bladder biopsy.
Her second discovery, published in the November, 1997 issue of the Journal of Urology, revealed that urine specimens from IC patients show alterations in the levels of certain epithelial growth factors, including a strikingly low concentration of HB-EGF, a contributor to epithelial cell growth, when compared to urine specimens from asymptomatic controls or patients with other forms of urogenital disease. This discovery further supports Keay’s hypothesis that IC may result from the inhibition of epithelial cell growth and regeneration. In addition to publication, she will present this work at the upcoming International Symposium on Interstitial Cystitis, co-sponsored by the Interstitial Cystitis Association and the National Institutes of Health.
"IC is very difficult to diagnose, and even more difficult to treat," says Keay. "Women often believe they have or are misdiagnosed as having a recurrent urinary tract infection, but because IC does not appear to be caused by bacteria, it doesn’t respond reliably to conventional antibiotic therapy. This can mean years of suffering. IC is an extremely painful, long-term, life-style altering problem that can continue for decades."
Through the University of Maryland’s Office of Technology Development, Keay is working with scientists at UroCor, a leading urology disease management company which markets directly to urologists and managed care organizations a comprehensive range of integrated products and services designed to assist in detection, diagnosis, treatment and management of complex urological disorders including IC. Under the arrangement, UroCor is providing funding to further Keay’s research into the antiproliferative peptide. UroCor is responsible for development of commercial products based on this research and its clinical validation, and would have the to right to exclusively license related processes and products resulting from her work on the antiproliferative peptide.
IC has no available cure at this time and no single treatment seems to work for everyone. There are a number of different treatments available. Sometimes treatment may be as simple as following prescribed dietary changes. In other cases, anti-inflammatory oral medications or even surgery are prescribed. It is initially diagnosed by ruling out other diseases that mimic its symptoms, including bladder cancer, sexually transmitted diseases, endometriosis, radiation cystitis, kidney problems, or vaginal infections.
Cystoscopy involves the insertion of a cystoscope into the urethra and up to the bladder, which is then distended by filling it with a liquid or gas, and can detect the kinds of inflammations, ulcers and pinpoint bleeding that indicate IC. Without anesthesia, this process is limited by either pain or a severe urge to urinate. A biopsy of bladder and urethra tissue is often removed during cystoscopy to help rule out bladder cancer and confirm bladder wall inflammation.
Dr. Keay and her colleagues at the University of Maryland School of Medicine, Drs. John Warren, Harry Johnson, Jr., Richard Marvel and Toby Chai, have formed an IC Clinic to study the causes of and research treatments for this painful, enigmatic disease. For more information on how to participate in research on interstitial cystitis, call 410/706-7560.
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