Page 101 - ITPS-7-2

INNOSC Theranostics and
Pharmacological Sciences ABT for NDO

IL-12, TNF-α, and NO synthase 2. The anti-scarring promotion of long-term psychological and social well-
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effect stems from preventing the expression of α-smooth being may facilitate advances in medical care to further
muscle actin (α-SMA) by pro-scarring myofibroblasts extend the individual life spans of people with SCI. 19
through the suppression of TGF-β1 promoter activity An additional problem frequently encountered by these
and canonical TGF-β signaling. Recent studies have also patients is AD, a potentially life-threatening condition
2
displayed that the key component within AM, i.e., HC-HA/ of the autonomic nervous system with an exaggerated
PTX3, can reprogram and de-differentiate pro-scarring reflexive increase in blood pressure. This occurrence is
myofibroblasts, which was mediated by SDF1-CXCR4 associated with severe headaches, bradycardia, facial
signaling followed by the activation of canonical BMP flushing, lower extremity sweating, and a significantly
signaling. These functions are especially relevant in increased risk of stroke by 300% to 400%. It is well known
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patients with NDO wherein pathologic processes, such as that NDO can increase afferent stimulation and trigger
chronic inflammation, unabated fibroblast proliferation, AD episodes in patients with high-level lesions. Thus, the
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and persistent myofibroblast activation, coupled with peripheral stimulation after high bladder pressures must
excessive extracellular matrix deposition, can disrupt the be resolved to prevent AD occurrence. Although the effect
normal healing cascade and promote the development of constipation on AD was not investigated in our study,
of contractile fibrosis. Hence, the use of ABT and other it is well known that this can also be a factor leading to
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similar modalities in patients with NDO is a promising AD and its consequences in patients. In future studies, we
therapeutic concept to reduce pathologic bladder will exclude patients with heavy constipation or document
inflammation and scarring in SCI patients.
methods of bowel evaluation. In our study, we found all
In this study, we evaluated the ability of ABT to patients had decreased episodes of AD at 12 weeks post-
promote rapid symptomatic improvements and long- ABT, likely due to their high bladder pressures being
term benefits in recalcitrant NGB patients with high-level resolved. Patients progressed from experiencing ADs
SCI. We have previously evaluated ABT in patients with daily before injection to none after injection. While the
interstitial cystitis/bladder pain syndrome, IDO, and RC immediate impact on QoL is clear, future studies are
and found symptomatic improvements as early as 2 weeks warranted to monitor the prevention of longer-term
post-injection. Specifically, the RC and IDO patients also complications (e.g., stroke) through the utilization of ABT.
3
exhibited increased bladder capacity based on voided
volume and MCC up to 12 weeks after ABT. Similarly, This was the first study to investigate ABT for the
in the current study, we reported the promising effects management of NDO in SCI patients, and this study
of ABT for NDO with improvements in patient-reported was not without limitations, which included the lack of
outcomes and functional data. The severity of urinary tract randomization, the small number of participants, and the
symptoms improved by 32% at 2-week post-injection and absence of a control group. Further studies to investigate
64% at 3-month post-injection based on the total Qualiveen the physiologic mechanism and duration of improvement,
score. This was associated with a 50% reduction in MDP as well as randomized placebo-controlled trials, should be
and a 105% improvement in MCC at 3-month post- performed to validate the promising results obtained in
injection. More importantly, the MDP was <40 cmH O in this study for ABT in neurogenic patients with SCI.
2
all patients after treatment, thereby reducing the potential 5. Conclusion
for upper urinary tract damage. The study also reported
long-term implications as the patients were predominantly We investigated ABT as a potential treatment option for
young, with an average age of 39.6 ± 13.6 years, and had a SCI-associated NDO. Further investigations are needed
full life ahead of them. to validate the effectiveness of ABT in this patient
population and determine treatment durability. More
Aside from preserving renal function, urinary
continence is also a significant factor affecting the patient’s research is required to develop a better understanding of
the mechanisms through which ABT treats these complex
QoL and long-term independence. The decreased bladder disorders.
compliance and increased pressure in these patients can
lead to persistent incontinence that ultimately damages Acknowledgments
the tissue integrity of the skin, which leaves patients
susceptible to skin breakdown, such as pressure injuries and None.
incontinence-associated dermatitis. Hence, increasing
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bladder compliance in these patients can directly affect Funding
their overall QoL. Likewise, a better understanding and None.

Volume 7 Issue 2 (2024) 5 doi: 10.36922/itps.2037