Interstitial cystitis, an autoimmune condition

Interstitial cystitis, also known as Painful Bladder Syndrome (IC/PBS), can feel just like a bladder infection with urinary frequency and discomfort or pain. The symptoms can range from mild to intense. I find this to be a fairly common, undiagnosed condition that is often not recognized as an autoimmune disorder. A study recently published in PLOS One (Public Libary of Science) presents an autoimmune mechanism for interstitial cystitis and reminds clinicians to be alert to the diagnosis:

"In this study, we show that the bladder specific uroplakin 3A-derived immunogenic peptide UPK3A 65–84, which contains the binding motif for IAd MHC class II molecules expressed in BALB/c mice, is capable of inducing experimental autoimmune cystitis in female mice of that strain. A highly antigen-specific recall proliferative response of lymph node cells to UPK3A 65–84 was observed, characterized by selectively activated CD4+ T cells with a proinflammatory Th1-like phenotype, including enhanced production of interferon γ and interleukin-2. T cell infiltration of the bladder and bladder-specific increased gene expression of inflammatory cytokines were observed. Either active immunization with UPK3A 65–84 or adoptive transfer of peptide-activated CD4+ T cells induced all of the predominant IC/PBS phenotypic characteristics, including increased micturition frequency, decreased urine output per micturition, and increased pelvic pain responses to stimulation with von Frey filaments."

Micturation = urination. In other words, the others were able to induce all the symptoms of interstitial cystitis by triggering these autoimmune inflammatory pathways. The authors conclude:

"Our study demonstrates the creation of a more specific experimental autoimmune cystitis model that is the first inducible model for IC/PBS that manifests all of the major symptoms of this debilitating condition."

Clinical note: In the presence of urinary frequency, scanty eliminations, bladder pain and other symptoms suggestive of a UTI but in the absence of infection, practitioners should consider interstitial cystitis and be alert to other manifestations of autoimmunity.