34 Researchers from Italy have investigated the efficacy of intravesical instillation of a naturally occurring peptide, nociceptin/orphanin FQ (N/OFQ) for the Sotrastaurin treatment of BPS/IC. Twenty-three subjects with BPS/IC received N/OFQ twice a week for 4 weeks by intravesical instillation. The authors noted a statistically significant decrease in the O’Leary-Sant IC problem index but not the O’Leary-Sant IC symptom Inhibitors,research,lifescience,medical index. There was a decrease in Visual Analogue Scale (VAS) and about half of the patients were satisfied with the results of treatment. These preliminary results suggest that N/OFQ may provide benefit to patients with BPS/IC and certainly further

randomized, placebo-controlled trials would be mandatory Inhibitors,research,lifescience,medical to confirm this initial impression.35 Intratrigonal injection of botulinum toxin A has been reported in patients with BPS/IC who have been refractory to first-line therapy. Investigators evaluated the therapeutic effect of repeated intratrigonal injection of onabotulinumA in 14 women with BPS/IC refractory to first-line treatment. The patients received four consecutive intratrigonal injections under general anesthesia. The investigators reported that all patients reported Inhibitors,research,lifescience,medical subjective improvement

following each injection and that each treatment provided symptomatic relief for a period of between 9 and 12 months. No cases of voiding dysfunction or urinary Inhibitors,research,lifescience,medical retention were reported. This study suggested that intratrigonal injection of botulinum toxin A is safe, effective, and has a maintained effect after repeated injection in patients with treatment refractory BPS/IC.36 Two studies that were more basic science in nature suggested further therapeutic avenues that should be explored in BPS/IC. A study with mice showed that treatment with selective cannabinoid receptor 2 (CB2) agonists reduced the severity of acrolein-induced

cystitis and inhibited bladder inflammation-induced increased peripheral sensitization to mechanical stimuli. The data would indicate that CB2 might play an inhibitory role in bladder inflammation and Inhibitors,research,lifescience,medical subsequent changes in pain perception. CB2 agonists have been developed and clinical trials are being initiated in 2011 for this particular indication.37 Another interesting Ketanserin and somewhat innovative basic science study investigated the beneficial effects of honey on histamine release from LAD2 cells. Honey has long been used for the treatment of wounds and has more recently demonstrated to have beneficial effects on wound healing. Mechanisms include antibacterial properties, cytokine interaction, and antioxidant effects as well as on mass cell activity. The investigators concluded that a constituent of most honeys inhibits spontaneous and stimulated mass cell degranulation in a cell line model. Certainly this interesting observation warrants further investigation as a possible intravesical agent in the treatment of BPS/IC.