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Therapeutic potential of intravesical injections of platelet‑rich plasma in the treatment of lower urinary tract disorders due to regenerative deficiency

Qian‑Sheng Kea, Jia‑Fong Jhanga, Teng‑Yi Linb, Han‑Chen Hoc, Yuan‑Hong Jianga, Yuan‑Hsiang Hsud, Hann‑Chorng Kuoa*

 

aDepartment of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan, bDepartment of Laboratory Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan, cDepartment of Anatomy, Tzu Chi University, Hualien, Taiwan, dDepartment of Pathology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
 
 

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

 

Abstract
 
The bladder urothelium plays an important role of barrier function to prevent influx of urinary toxic substance and bacteria. When there is insult to the urinary bladder, the urothelium will start to regenerate on injury. However, several factors might affect the regenerative function of bladder urothelium, including aging, chronic inflammation, and system diseases such as diabetes and chronic kidney diseases (CKDs). Impairment of bladder mucosal regenerative function might result in defective urothelial cell differentiation as well as barrier function, which might be the underlying pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) and recurrent bacterial cystitis. Our previous immunohistochemistry (IHC) study and electron microscopic study revealed that the loss of normal umbrella cells and defective junction proteins in IC/BPS and recurrent cystitis. Platelet‑rich plasma (PRP) has been previously used in many medical aspects as regenerative medicine therapy. PRP is rich in many growth factors and cytokines which modulate the process of inflammation and regeneration in the wound healing process. Recent pilot studies have shown that intravesical PRP injections improve IC symptoms and yield a success rate of 70% at 3 months after treatment. The results highly suggest
that PRP injection could improve urothelial regenerative function and reduce chronicinflammation in IC patients. This article reviews recently published researches on theurothelial dysfunction biomarkers, urothelial cell differentiation, and urinary regenerative
and inflammatory proteins in patients with IC/BPS or recurrent bacterial cystitis. Thepathophysiology of the insufficient urothelial regeneration and differentiation; and chronicinflammation may induce urothelial dysfunction and further affect the regenerative ability
of the diseased bladder urothelium in IC/BPS and recurrent bacterial cystitis are discussed.

 

Keywords: Bladder urothelium, Interstitial cystitis, Platelet‑rich plasma

 

 

 

 

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