Conditions, Interstitial Cystitis

Is Interstitial Cystitis An Autoimmune Condition?

I’ve recently come across an info-graphic on Twitter, claiming that interstitial cystitis (IC) is an autoimmune condition where the immune system attacks the bladder lining, causing the painful symptoms of IC. This reminded me that it’s about time that I explore this question further: Is interstitial cystitis an autoimmune condition or not?

The short answer is: maybe sometimes.





What Is Autoimmunity?

The immune system is the body’s defence mechanism against foreign intruders, such as pathogens.

It has different mechanisms of defence:

  • Innate immunity (inborn), which is non-specific and uses barriers, anti-microbial fluids and a non-specific immune response to ward off intruders.
  • Acquired immunity, which uses proteins called ‘antibodies’ that are specific for certain pathogens and help to destroy them. These antibodies are usually formed during an infection and once they are present, protect us from subsequent infections with the same pathogen.

In autoimmunity, the immune system mistakenly recognizes our own body tissues as an invader and the latter mechanism goes awry and antibodies (called auto-antibodies) are formed against certain body tissues.

These auto-antibodies then launch attacks against a particular body tissue when triggered, leading to inflammation and damage, which over time compromises the health of the affected area.

For example, in Hashimoto’s Thyroiditis or Grave’s disease the immune system produces antibodies against thyroid tissue. When triggered, these antibodies mount an attack against thyroid tissues, damaging the organ so that over time output of thyroid hormones is reduced, leading to symptoms of low thyroid activity.

To give another example, in rheumatoid arthritis the immune system attacks connective tissue and cartilage in joints, leading to inflammation, pain and stiffness.

The Theory behind IC as an Autoimmune Condition

In a model of autoimmune interstitial cystitis, the above process would apply to the bladder.

The immune system would produce antibodies to the tissue of the bladder lining, attacking it when triggered.

Over time, this could lead to inflammation and pain in the bladder and other symptoms associated with IC.

Damage to bladder tissue could also result in lesions, such as experienced in IC with Hunner’s lesions (a.k.a Hunner’s ulcers).

What does the Evidence say?

The idea of IC being an autoimmune condition still seems to be controversial. But some evidence points to the fact that the idea can’t be completely dismissed.

The reason why autoimmunity has been suggested as a possible root cause, is that sufferers of IC are predominantly female and that there is often an overlap with other autoimmune disorders, such as Lupus or Sjoergen’s [1].

When mice were artificially put into a state of bladder autoimmunity, they developed symptoms that were consistent with the clinical features of IC [2, 3], plus increased mast cell counts and activation in the bladder [4]. Now this doesn’t proof that IC is autoimmune in nature but rather that autoimmunity is capable of producing the symptoms of IC.

Some more solid findings support the potential for autoimmunity:

  • Some cases of IC with Hunner’s lesions have shown increased ‘clonal expansion of B-cells’ – B-cells are immune cells and their clonal expansion is associated with autoimmunity [1, 5]. However, clonal B-cells can also be a result of bacterial or viral infections [1], therefore they could be a marker of hidden infections rather than autoimmunity.
  • IC with Hunner’s lesions has been associated with an up-regulated expression of a genetic pathway (called CXCR3) associated with allergic and autoimmune conditions [5].
  • In one study, 36% of IC sufferers showed auto-antibodies in blood tests that looked different to auto-antibodies associated with other conditions and therefore may be specific for the bladder [6].

Conclusion

As you will hopefully have gathered from the above information, there is no conclusive evidence that IC is an autoimmune condition.

However, in some cases it may have an autoimmune component, which seems to be more likely in IC with Hunner’s lesions.

This shows once again that rather than one cause, there may be several causes of IC capable of causing the same symptoms.

Now I’d like to hear from you: Do you suffer from several autoimmune disorders and think your IC may be connected? Let me know in the comments!




Pin it for later:

Sources

  1. Maeda, Daichi et al Hunner-Type (Classic) Interstitial Cystitis: A Distinct Inflammatory Disorder Characterized by Pancystitis, with Frequent Expansion of Clonal B-Cells and Epithelial Denudation Plos One November 20, 2015https://doi.org/10.1371/journal.pone.0143316 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143316
  2. Luber-Narod, J. Experimental autoimmune cystitis in the Lewis rat: a potential animal model for interstitial cystitis et al. Urol. Res. (1996) 24: 367. https://doi.org/10.1007/BF00389795 https://link.springer.com/article/10.1007%2FBF00389795?LI=true#citeas
  3. Izgi, Kenan et al Uroplakin Peptide-Specific Autoimmunity Initiates Interstitial Cystitis/Painful Bladder Syndrome in Mice Plos One August 16, 2013https://doi.org/10.1371/journal.pone.0072067 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072067
  4. Bicer, Fuat et al Chronic pelvic allodynia is mediated by CCL2 through mast cells in an experimental autoimmune cystitis model Renal Physiology [Volume 308, Issue 2, January 2015, Pages F103-F113] http://www.physiology.org/doi/abs/10.1152/ajprenal.00202.2014
  5. Akiyama, Y. et al. Increased CXCR3 Expression of Infiltrating Plasma Cells in Hunner Type Interstitial Cystitis. Rep. 6, 28652; doi: 10.1038/srep28652 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919639/
  6. Ochs, R. et al Autoantibodies in interstitial cystitis. J Urol. 1994 Mar;151(3):587-92. https://www.ncbi.nlm.nih.gov/pubmed/8308964

 

 

 

 

12 Comments

  • Reply

    Michelle

    December 10, 2017

    I have Sjogrens Syndrome I take cyclosporine to help with the intercystitial cystitis.

    • Reply

      Layla

      December 10, 2017

      Does the cyclosporine help?

      • Reply

        Michelle

        December 10, 2017

        Yes made a huge difference but a lot of Dr’s no not want to RX it because it can cause kidney issues. Its actually used for people who have had kidney transplants. I am having kidney issues now my Rheumy thinks its from the cyclosporine but my nephrologist said Sjogren’s can attack the kidney’s I never knew that. Before I started the cyclosporine my kidney function was at a 78 which was already showing some mild issues so its definitely not from the cyclosporine. Helps with the dry eyes and dry mouth also.

  • Reply

    Giftbearer

    December 15, 2017

    This is an interesting article. The cause may be both hidden infection and autoimmunity (the immune system may be trying to get at the infection and just be unable to locate exactly where to attack it so it causes collateral damage. I believe this really is what autoimmunity is (that there is actually something there and the body doesn’t lie).

    • Reply

      Layla

      December 15, 2017

      I love your take on this, it makes sense! Would be interesting to see some studies into it!

  • Reply

    Marilyn Hebert

    January 5, 2018

    My Sjogren’s symptoms started at the age of six. IC with Hunner’s lesions started at the age of 39. I read at about that time that up to 30% of Sjogren’s patients may get IC. There is definitely a connection between these two diseases. As Sjogren’s affects the entire body, it would seem that the bladder is just one of the organs affected.

  • Reply

    Annabelle

    February 23, 2018

    I have Sjogrens also which has been getting difficult to manage .
    I too have interstitial systitis and recently IBS. Both of the new problems are seriously affecting my life and think the IC is is resulting from the Sjoggers. I intend to ask my doctor about this connection but so many doctors do not understand Sjrogens and immedeathly dismiss it as not important

    • Reply

      Michelle

      May 14, 2018

      Some Rheumatologists treat Sjogrens with IvIG read up on it. 🙂

  • Reply

    Lisa

    May 14, 2018

    I recently was diagnosed with PBC (Primary Biliary Cholangitis… formerly known as Primary Biliary Cirrhosis) which is an autoimmune liver disease. I am thought to likely have Sjogrens as well and was diagnosed with IC years ago. The GI doctor said it is common to have more than one autoimmune disorder when you have one.

  • Reply

    Pat

    June 26, 2018

    I have interstitial cystitis with Hunner’s lesions and Petechial hemorrhages. I have IBS and now they are suspecting Lupus too. I truly believe it is an autoimmune disease. My body is attacking and destroying the lining of my bladder. Doesn’t make sense as to why there is no agreement in this, when the definition of auto immune disease is when your body attacks itself. Frustrating for those of us who need it to be on the list of disabilities and isn’t. Getting better with approving it, but not to where it should be. Thx for publishing and listening.

    • Reply

      Layla

      June 26, 2018

      I think the reason there is no agreement is because most ‘syndromes’ are multifactoral, i.e. there are different causes. The disease name is really just a description of the symptoms. I have spoken to many women who actually just had an undiagnosed chronic UTI, which had been diagnosed as IC because gold standard testing missed it. I heard from others who had their bladder wall damaged from toxins.
      Gut issues are common in most people I have spoken to (including myself) and they also contribute to autoimmunity, so I think this is one underlying factor for most.

  • Reply

    JW

    August 28, 2018

    If you have an autoimmune disease it is interesting to follow research in the role of the microbiome/gut and the testing being done with FMT. Currently only approved for one bowel disease but tests for use on MS and Psoriasis have started. See Google Scholar for more info.

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