Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P30536 (PBS)
 9,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a severely debilitating condition. Its cause is poorly understood; therapy is symptomatic and often unsuccessful. To study urothelial involvement, we characterized the keratin phenotype of bladder urothelium in 18 patients with PBS/IC using a panel of 11 keratin antibodies recognizing simple keratins found in columnar epithelia (keratins 7, 8, 18, and 20) and keratins associated with basal cell compartments of squamous epithelia (keratins 5, 13, 14, and 17). We also tested 2 antibodies recognizing more than 1 keratin also directed against basal cell compartments of squamous epithelia (D5/16 B4 and 34betaE12). Bladder urothelium in PBS/IC showed distinct differences in the profiles of keratins 7, 8, 14, 17, 18, and 20 compared with literature reports for normal bladder urothelium. These were characterized by a shift from the normal bladder urothelial keratin phenotype to a more squamous keratin profile, despite the lack of morphologic evidence of squamous epithelial differentiation and a loss of compartmentalization of keratin expression. The severity of these changes varied between biopsy specimens. Whether these changes are primary or secondary to another underlying condition remains to be determined.
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PMID:Keratin expression profiling of transitional epithelium in the painful bladder syndrome/interstitial cystitis. 1648 98

Interstitial cystitis is an enigmatic and frustrating condition to manage as a physician and to cope with as a patient. Traditionally, it has been defined as a chronic sterile inflammatory disease of the bladder of unknown aetiology. However, the International Continence Society prefers the term painful bladder syndrome and it has been decided to follow this terminology and refer to the disease as painful bladder syndrome/interstitial cystitis (PBS/IC). The condition is characterized by bladder pain, urinary frequency, urgency and nocturia. The quality of life of patients with PBS/IC is significantly degraded. Its aetiology is unknown, but might involve microbiologic, immunologic, mucosal, neurogenic and other yet unidentified agents. History, physical examination, urine analysis and culture as well as cystoscopy and hydrodistension are useful diagnostic tools but the final diagnosis tends to be a diagnosis of exclusion. This article will review the major theories of aetiology for PBS/IC and discuss diagnosis as well as the current treatment options with relevance to the proposed aetiologies.
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PMID:Interstitial cystitis. 1702 74

The objective of this paper was to establish whether patients with confirmed painful bladder syndrome/interstitial cystitis (PBS/IC) presenting with symptoms of UTI have actual bacteriuria vs a flare of their PBS/IC symptoms. One hundred and six (n = 106) consecutive female patients (mean age 39.8 +/- 14 years) with newly diagnosed IC were identified and followed longitudinally for 24 months. At the initial visit and at all subsequent visits, urinary specimens were obtained by sterile catheterization (Bard 14Fr female) and cultured for bacteria. Eight patients had an initially positive urine culture, and repeat cultures 8 weeks after treatment were all negative. Once sterile urine was established, the diagnosis of PBS/IC was confirmed. A pelvic pain/urgency/frequency (PUF) questionnaire score was obtained from 89 patients. After the diagnosis of PBS/IC, all patients received multimodal treatment. Patients were instructed to present to the office whenever they developed symptoms of UTI, at which time a sterile catheter specimen was obtained and sent for culture. Greater than 10(3) colonies were considered positive. Patients who did not report flares were contacted to establish whether unreported treatments were given. Seventy-two patients (68%) had no UTI episodes or flares. The remaining 34 patients (32%) presented with 54 flares, of which 44 were culture-negative and 10 were culture-positive. A single flare was reported by 21 patients during the 24 months, with three positive cultures (14.3%). Recurrent UTI symptoms (two to four flares) were seen in a small group (n = 13) for a total of 33 flares. Of these, seven had two flares each (12 negative, 2 positive), five had three flares each (12 negative, 3 positive), and one patient had four flares (two negative, two positive). Therefore, within the group with recurrent symptoms, seven positive cultures were obtained for a rate of recurrent bacteriuria of 6.6% (7/106). Nine of the 10 positive bacterial cultures were due to gram-negative bacteria: Escherichia coli (n = 6), Proteus mirabilis (n = 1), Klebsiella pneumonia (n = 1), and Citrobacter sp. (n = 1). One grew Streptococcus sp. There was no difference between the flare group and nonflares in regards to age or PUF scores between groups. This study is the first to report on the low incidence of confirmed UTIs in a large group of PBS/IC patients followed longitudinally. These data suggest that only a small number of PBS/IC patients with UTI symptoms have positive urine cultures (9.4%; 10/106). Although the symptoms of recurrent UTI are prevalent in IC patients, the incidence of confirmed recurrent UTIs is only 6.6%. Because the flares of IC are usually self-limiting, treatment response to antibiotics may be misleading in light of the low incidence of positive urine cultures. These data suggest that the symptom flares of IC are not usually associated with recurrent UTI and, therefore, are likely due to a triggering of the other painful mechanisms involved in IC patients who are culture-negative.
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PMID:There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally. 1703 70

Mast cells are involved in allergic reactions, where they secrete numerous vasoactive, inflammatory and nociceptive mediators in response to immunoglobulin E (IgE) and antigen. However, they have also been implicated in inflammatory conditions, such as painful bladder syndrome/interstitial cystitis (PBS/IC), irritable bowel syndrome (IBS) and migraines, all of which occur more often in women and are exacerbated during ovulation, but are suppressed during pregnancy. Mast cells express high affinity estrogen receptors and estradiol augments their secretion, while tamoxifen inhibits it. Here we report that progesterone (100 nM), but not the structurally related cholesterol, inhibits histamine secretion from purified rat peritoneal mast cells stimulated immunologically or by substance P (SP), an effect also documented by electron microscopy. These results suggest that mast cell secretion may be regulated by progesterone and may explain the reduced symptoms of certain inflammatory conditions during pregnancy.
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PMID:Progesterone inhibits mast cell secretion. 1716

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disease of unknown aetiology, characterised by severe pressure and pain in the bladder area or lower pelvis that is frequently or typically relieved by voiding, along with urgency or frequency of urination in the absence of urinary tract infections. PBS/IC occurs primarily in women, is increasingly recognised in young adults, and may affect as many as 0.1-1% of adult women. PBS/IC is often comorbid with allergies, endometriosis, fibromyalgia, irritable bowel syndrome and panic syndrome, all of which are worsened by stress. As a result, patients may visit as many as five physicians, including family practitioners, internists, gynaecologists, urologists and pain specialists, leading to confusion and frustration. There is no curative treatment; intravesical dimethyl sulfoxide, as well as oral amitriptyline, pentosan polysulfate and hydroxyzine have variable results, with success more likely when these drugs are given together. Pilot clinical trials suggest that the flavonoid quercetin may be helpful. Lack of early diagnosis and treatment can affect outcomes and leads to the development of hyperalgesia/allodynia.
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PMID:Treatment approaches for painful bladder syndrome/interstitial cystitis. 1728 85

Resiniferatoxin (RTX) and botulinum toxin subtype A (BTX-A) are increasingly viewed as potential treatments for lower urinary tract symptoms (LUTS) refractory to conventional therapy. RTX, a capsaicin analogue devoid of severe pungent properties, acts by desensitizing the transient receptor potential vanilloid type 1 (TRPV1) receptor and inactivating C-fibers. BTX-A cleaves soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins in afferent and efferent nerve endings, therefore impeding the fusion of synaptic vesicles with the neuronal membrane necessary for the release of neurotransmitters. In patients with neurogenic and idiopathic detrusor overactivity, RTX and BTX-A have been shown to increase the volume to first detrusor contraction, increase bladder capacity, and improve urinary incontinence and quality of life. Recent data also suggest a role for these neurotoxins in treating urgency, the primary symptom in overactive bladder (OAB) syndrome. Furthermore, experimental data strongly support the use of both neurotoxins in the treatment of pain and frequency in patients with interstitial cystitis/painful bladder syndrome (IC/PBS), although the results from available clinical trials for this use are still inconclusive. In spite of promising results overall, it should be made clear that the administration of these neurotoxins is still considered an experimental procedure and that more clinical studies are necessary before a license for their use will be issued by health authorities.
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PMID:Resiniferatoxin and botulinum toxin type A for treatment of lower urinary tract symptoms. 1770 61

Interstitial cystitis/painful bladder syndrome (IC/PBS) is characterized by urinary frequency, urgency, and pelvic pain in the absence of any other identifiable pathology. Initial identification of IC/PBS is challenging, as patients may have a range of symptoms that overlap with other disorders, including urinary tract infection (UTI). These patients may be treated empirically with antibiotics; however, many patients with such symptoms are actually culture negative and are later diagnosed with IC/PBS. This review describes the importance of recognizing the symptom overlap between IC/PBS and UTI and focuses on approaches to the diagnosis and management of IC/PBS. Physicians can improve patient care by considering IC/PBS early in the differential diagnosis.
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PMID:Interstitial cystitis/painful bladder syndrome: appropriate diagnosis and management. 1793 71

Vulvodynia affects 25% of women with painful bladder syndrome/interstitial cystitis (PBS/IC). The objective of our study was to clinically evaluate the association of PBS/IC and vulvodynia and possible contributing factors. To our knowledge, this has not been reported. Seventy women with PBS/IC were evaluated from December 2005 to December 2006 with a comprehensive history and exam. Two groups were formed--those with vulvodynia and those without vulvodynia for comparison. Of the women, 51.4% had vulvodynia and 48.6% did not have vulvodynia using our operative definition. Average levator pain levels were significantly greater in those with vulvodynia. There was no significant difference in the total number of lifetime pelvic surgeries, history of sexually transmitted infections (STIs), vaginitis, or abuse history between groups. The correlation of vulvodynia and PBS/IC may have been underestimated. Research needs to explore the link between precipitating factors, symptoms, and effective treatment options for PBS/IC and vulvodynia.
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PMID:Painful bladder syndrome/interstitial cystitis and vulvodynia: a clinical correlation. 1803 12

The aim of this study is to evaluate the efficacy of intravesical hyaluronan therapy in interstitial cystitis/painful bladder syndrome (IC/PBS). One hundred twenty-six patients with IC/PBS and an average disease duration of 6.1 years were treated with weekly instillations of a 50-cm3 phosphate-buffered saline solution containing 40 mg sodium hyaluronate. To be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder. Data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy. Additional questions evaluated the therapeutic impact on quality of life. A positive and durable impact of hyaluronan therapy on IC/PBS symptoms was observed--103 (85%) of the patients reported symptom improvement (> or =2 VAS units). The mean initial VAS score of 8.5 decreased to 3.5 after therapy (p < 0.0001). Out of 121 patients, 67 (55%) remained with no or minimal bladder symptoms after therapy (VAS 0-2). The majority (101, 84%) reported significant improvement of their quality of life. Intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years. In general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations. Timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy. The present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%.
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PMID:Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. 1809 27

The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid (HA) 1.6% and chondroitin sulfate (CS) 2.0% in patients with refractory painful bladder syndrome/interstitial cystitis (PBS/IC) and to observe their impact on Quality of Life. Twenty-three women were enrolled. They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months. Mean follow-up after completion of therapy was 5 months. We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency (p = 0.045), urgency (p = 0.005), and pain (p = 0.001). The O'Leary-Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index resulted in a significant improvement in both scores (p = 0.004 and 0.01, respectively). The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score (p = 0.001). This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC.
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PMID:A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. 1833 95


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