Human Anti-IgE Monoclonal Antibody Blocks Passive Sensitization of Human and Rhesus Monkey Bladder

Neurogenic inflammation of the bladder

Current evidence suggests multiple and redundant pathways through which the nervous system can initiate, amplify, and perpetuate inflammation. Many of the processes initiated by neurogenic inflammation have the capacity to recruit the participation of additional sensory nerves. These observations indicate that effective strategies for prevention or treatment of neurogenic inflammation of the bladder will entail or require intervention at multiple points. It has been observed that pain management in the future will be based on selective intervention tailored to the specific processes modulating pain perception in individual patients. It is exciting to contemplate the same approach to prevention and treatment of neurogenic bladder inflammation.

New agents for the medical treatment of interstitial cystitis

Interstitial cystitis (IC) is a painful, sterile, disorder of the urinary bladder characterised by urgency, frequency, nocturia and pain. IC occurs primarily in women but also in men with recent findings indicating that chronic, abacterial prostatitis may be a variant of this condition. The prevalence of IC has ranged from about 8 - 60 cases/100,000 female patients depending on the population evaluated. About 10% of patients have severe symptoms that are associated with Hunner's ulcers on bladder biopsy; the rest could be grouped in those with or without bladder inflammation. Symptoms of IC are exacerbated by stress, certain foods and ovulatory hormones. Many patients also experience allergies, irritable bowel syndrome (IBS) and migraines. There have been various reports indicating dysfunction of the bladder glycosaminoglycan (GAG) protective layer and many publications showing a high number of activated bladder mast cells. Increasing evidence suggests that neurogenic inflammation and/or neuropathic pain is a major component of IC pathophysiology. Approved treatments so far include intravesical administration of dimethylsulphoxide (DMSO) or oral pentosanpolysulphate (PPS). New treatments focus on the combined use of drugs that modulate bladder sensory nerve stimulation (neurolytic agents), inhibit neurogenic activation of mast cells, or provide urothelial cytoprotection, together with new drugs with anti-inflammatory activity.

Production of a Chimeric Form of CD23 That Is Oligomeric and Blocks IgE Binding to the FcεRI

The low affinity receptor for IgE (FcεRII/CD23) has previously been shown to interact with IgE with a dual affinity. Three chimeric constructs were created containing the lectin domain (amino acids 172–188) or the “neck” and lectin domain (amino acids 157–188) attached to subunits of oligomeric proteins. All chimeras were incapable of interacting with IgE with either a high or low affinity, indicating that the α-helical stalk of CD23 is important for orienting the lectin heads such that an interaction with IgE can occur. This concept received further support in that a chimeric CD23 composed of the human CD23 stalk and the mouse CD23 lectin head bound mouse IgE with a dual affinity, but could only bind rat IgE with a low affinity. Effort was next concentrated on a construct consisting of the entire extracellular (EC) region of CD23. A mutation to the first cleavage site of CD23 (C1M) resulted in a more stable molecule as determined by a decrease of soluble CD23 release. A soluble chimeric EC-C1M was prepared by attaching an isoleucine zipper to the amino terminus (lzEC-C1M). The interaction with IgE by lzEC-C1M was found to be superior to that seen with EC-CD23. The lzEC-C1M could inhibit binding of IgE to both CD23 and the high affinity receptor for IgE, FcεRI, providing further evidence for a strong interaction with IgE. FcεRI inhibition (∼70%) was seen at equimolar concentrations of lzEC-C1M, implying the effectiveness of this chimera and suggesting its potential therapeutic value.

Anti-immunoglobulin E antibody treatment blocks histamine release and tissue contraction in sensitized mice

Inhibition of antigen-specific IgE response has been shown to lead to amelioration of allergic disease symptoms. In an effort to design a therapy aimed at decreasing IgE levels, we reported previously that treatment of mice with an anti-IgE antibody coincident with the primary antigen immunization resulted in significant decreases in antigen-specific IgE synthesis, without substantially altering IgG levels. In the present study, we employed this mouse model and a surrogate antibody to investigate the capacity of anti-IgE treatment to block an established IgE response in vivo. Results of these experiments suggest that anti-IgE treatment concomitant with an antigen boost results in removal of detectable circulating IgE for at least 7 weeks (the duration of the study). Moreover, tissues removed from mice following anti-IgE treatment failed to release histamine and contract in response to antigen challenge ex vivo. These findings demonstrate that reduction of circulating IgE correlates to an inhibition of tissue mast cell sensitization and mediator release in response to antigen challenge and further supports the concept of anti-IgE treatment as a promising therapy for the treatment of allergic disease.