Nov 23 2021 in the prestigious Journal of urology a new study was published giving new insight into the pathogensis of bladder ulcers also called Hunner lesions.
This new study took biopsies of the ulcer and healthy tissue in the same bladder from 25 patients and ran a variety of gene analyses. Many gene's were found to be upregulated including HIF1-alpha, IL-2, and IFN-γ, and the HIF1-alpha protein was found to be significantly elevated compared to normal tissue from the same bladders. These genes and the HIF1-apha protein indicate that the tissue is under ischemia and experiencing inflammation (IL-2 and IFN-γ, however other inflammatory cytokines were not elevated). Almost everyone with these conditions understand inflammation is an important factor in their condition, but ischemia is a newer consideration and very important. Ischemia means there is a lack of blood flow to the tissue.
So what could be causing poor blood flow?
- Atherolscerosis - the build up of plaques in arteries
- Smoking is a major risk factor for ischemia
- A deficiency of L-arginine leading to underproduction of nitric oxide (NO) a potent vasodilator
- Inherited genetic variations in the NO pathways
- Damaged vasculature from previous pelvic surgeries
- Trauma to the pelvis
- Physical inactivity
- Older age
- Blood clots
- Underlying vascular disease
Determining the cause is always the key to resolving the illness and a primary focus of all Naturopathic Doctors.
The molecules they didn't find are also important to know for these patients.
They did not find elevated mRNA levels of inflammatory cytokines other than the 2 mentioned above, or "histological features such as lymphoplasmacytic and mast cell infiltration, epithelial denudation, and CD4/CD8 T-lymphocyte ratio". Meaning...
- There was no presence of lymphocytes/plasma cells (an important part of our immune system for attacking pathogens and diseases such as cancer). This does not rule out infection but it is an indicator it may not be present.
- No mast cells which are typically present during an allergic response (environmental or food/medications/supplements), inflammation, autoimmunity, and bacteria and parasitic infections.
- No loss of surface tissue (epithelium).
- And no alteration in the CD4/CD8 t-lymphocyte ratio which would point to immunodeficiency or autoimmunity if it had been altered.
Feel free to read the abstract here: https://www.practiceupdate.com/c/126048/2/3/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_uro&elsca4=urology&elsca5=newsletter&rid=NTQwMjU1NTE1MDQ3S0&lid=20845155