Immunomodulators for treatment of interstitial cystitis.

t w m m c a t t s h s n t p t i e i b c c nterstitial cystitis (IC) is a disorder of the urinary bladder characterized by urgency, freuency, nocturia, and chronic pelvic pain. The ain pathologic findings include dysfunction of he bladder glycosaminoglycan protective layer1 nd a high number of activated bladder mast cells2; hese processes could lead to neurogenic inflamation and immune damage of the bladder wall, ith subsequent chronic nerve sensitization3 (Fig. ). As IC has become better known and the diagostic criteria presently do not necessarily include ystoscopy, it has been estimated that 1 million omen in the United States have IC.4 Many paients with IC also have allergies, fibromyalgia, and rritable bowel syndrome,5 all of which are exacerated by physical or emotional stress.6,7 In fact, a ecent publication has linked IC and panic disorer genetically, and it is of interest that benzodiazpines, which are used in the treatment of panic isorder, can bind to mast cells, leading to inhibiion of serotonin release.8 Despite almost 20 years of research, approved reatments for IC are limited to intravesical adminstration of dimethylsulfoxide (Rimso) and oral entosanpolysulfate (Elmiron)9; recent findings, owever, have challenged their universal effectiveess.10 In view of the above and because IC pathoenesis appears to be multifactorial,11,12 the treat-