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Infection of a ruptured aortic aneurysm and an aortic graft with bacille Calmette-Guérin after intravesical administration for bladder cancer.

A case of aortic graft infection with bacille Calmette-Guérin (BCG) is described. The graft was placed during urgent repair of a ruptured abdominal aortic aneurysm 2 years after intravesical administration of BCG for grade II transitional cell carcinoma of the bladder with associated carcinoma in situ. At the time of operation, no gross evidence of infection was found and pathologic examination of the aortic wall was unremarkable. Aortic graft infection with BCG was diagnosed 1 year after placement of the graft. Retrospective examination of formalin-fixed, paraffin-embedded aortic wall and thrombus removed at the time of graft placement by the polymerase chain reaction technique demonstrated the presence of mycobacterial DNA. The patient's condition improved with medical therapy during an observation period of 18 months with near total resolution on computed tomography scanning. Ultimately (20 months later), an aortoenteric fistula developed that required graft removal and axillobifemoral bypass.

Administration, Intravesical↗

Pharmacokinetics of aminolevulinic acid after intravesical administration to dogs.

PURPOSE: To examine the stability and systemic absorption of aminolevulinic acid (ALA) in dogs during intravesical administration. METHODS: Nine dogs received an intravesical dose of ALA either with no prior treatment, after receiving ammonium chloride for urinary acidification, or after receiving sodium bicarbonate for urinary alkalinization. Urine and blood samples collected during and after administration were monitored for ALA using an HPLC assay developed in our laboratories. Concentrations of pyrazine 2,5-dipropionic acid, the major ALA degradation product, and radiolabeled inulin, a nonabsorbable marker for urine volume, were also determined. RESULTS: Less than 0.6% of intravesical ALA doses was absorbed into plasma. Urine concentrations decreased to 37% of the initial concentration during the 2 hour instillation. Decreases in urinary ALA and radiolabeled inulin concentrations were significantly correlated, indicating that urine dilution accounted for over 80% of observed decreases in urinary ALA. ALA conversion to pyrazine 2,5-dipropionic acid was negligible. CONCLUSIONS: These studies demonstrate that ALA is stable and poorly absorbed into the systemic circulation during intravesical instillation. Future studies utilizing intravesical ALA for photodiagnosis of bladder cancer should include measures to restrict fluid intake as a means to limit dilution and maximize ALA concentrations during instillation.

Administration, Intravesical↗

[Radioimmunoimaging of bladder tumor with the intravesical administration of technetium -99m labelled monoclonal antibody].

OBJECTIVE: To make radioimmunoimaging of bladder tumor simple, safe and reliable. METHODS: Anti-human bladder carcinoma cell line BIU-87 monoclonal antibody-BDI-1 was labelled with technetium -99m by direct mercaptoethanol reducing method. RESULTS: The labelling rate was 69.6% and the radiochemistry pruity was higher than 95%. 33 patients received radioimmunoimaging of bladder tumor with the intravesical administration of technetium -99m labelled monoclonal antibody. The false positive rate was zero. 88.5% of all 29 bladder cancer patients had got positive immunoscintigraphy results, and 65.2% of them were confirmed by cystoscopic results. Both primary and recurrent tumor could be detected clearly and the smallest tumor detected was 0.5 cm in diameter. There were some differences between the radioimmunoimaging and cystoscopic results in 7 of 11 multitumor cases, which included tumor size, number and location. CONCLUSION: It is required to use more suitable isotopes and/or monoclonal antibodies to increase its sensitivity.

Administration, Intravesical↗

Immunological aspects of intravesical administration of Bacillus Calmette-Guérin (BCG) in the guinea pig.

The only form of effective immunotherapy for human cancer is the intravesical administration of BCG in the treatment of superficial bladder tumors. In this study BCG was administered intravesically (once a week for six consecutive weeks) in guinea pigs to investigate the immune response. Both specific immune responses against BCG itself and nonspecific immune responses such as leukocyte subset distribution, mitogenic (ConA, PHA, LPS) lymphocyte stimulation and spontaneous cytotoxic (NK and LAK cell) activity were determined in the regional draining (iliac) lymph node and in the spleen. The PPD skin test became positive after the fourth intravesical instillation of BCG when 1 X 10(5) culturable particles or higher dosages of BCG were administered. A low dose of 1 X 10(3) c.p. of BCG induced a positive PPD skin reaction in 2 of 4 animals after six BCG instillations. After six BCG instillation BCG immune lymphocytes were present both in the iliac lymph nodes and in the spleen. No differences in mitogenic responses to ConA, PHA and LPS were observed in iliac lymph nodes or the spleen between placebo or BCG treated animals. In the regional iliac lymph nodes a significantly increased number of leukocytes was present. These lymph node cells showed a significant increase in the expression of MHC class II (Ia) immune response antigen on their surface. In the spleen no differences were observed after BCG administration regarding the number of cells present and in terms of the Ia antigen expression of the leukocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗

Induction of tumour necrosis factor-alpha (TNF-alpha) mRNA in bladders and spleens of mice after intravesical administration of bacillus Calmette-Guérin.

Intravesical bacillus Calmette-Guérin (BCG) therapy is highly effective in the therapy of carcinoma in situ of the bladder, but the mechanism of BCG immunotherapy is not clearly understood. We studied the production of TNF-alpha in spleens and bladders of mice after intravesical BCG or BCG/interferon-gamma (IFN-gamma) instillation. Significant change of TNF-alpha mRNA expression of spleens and bladders of C3H/He mice was observed after intravesical BCG instillation, although intravesical IFN-gamma therapy 3 days after BCG instillation to maintain the activated state of monocyte/macrophage lineage cells did not show a significant change of TNF-alpha mRNA, compared with that of BCG therapy alone. Maximal production of TNF-alpha mRNA in spleens of mice was seen after the first or second intravesical BCG instillation, and production of TNF-alpha mRNA in bladders was also increased after intravesical BCG instillation. The increment of TNF-alpha production by BCG stimulation in HL-60, a promyelocytic leukaemic cell line, and peripheral blood mononuclear cells in vitro may support the in vivo effect of BCG therapy on the bladder. These data show that local production of TNF-alpha as well as systemic production by intravesical BCG treatment may correlate with one of the mechanisms of BCG immunotherapy of superficial bladder cancer.

Administration, Intravesical↗

Behavior and resorption of mitomycin C following multiple intravesical administrations.

Although several pharmacological data of intravesical mitomycin C (MMC) are available now, data about resorption following subsequent intravesical instillations with different instillation times are lacking. We have analyzed MMC concentrations in blood plasma and urine following eight subsequent instillations, with 0.5- and 1.0-h instillation times. The relationships between urinary pH, urinary MMC concentrations, and MMC blood plasma concentrations were determined, as well as the stability of MMC in urine at pH 5-8 at 37 degrees C. An average of 40.3 and 46.4% of the total parent drug was recovered for the 0.5- and 1.0-h instillations, respectively. Blood plasma concentrations of MMC could be measured in nearly all patients and were independent of instillation times, urine concentration, or urinary pH. Resorption of MMC and recovery was stable during eight subsequent instillations. It was demonstrated that MMC can be degradated in urine at physiological conditions (pH less than 6; 37 degrees C). However, neither an influence of prolongation of the instillation time on MMC recovery from urine, nor a significant correlation between urinary pH and urinary MMC concentrations could be demonstrated. Since MMC can be degradated at pH less than 6 within 0.5 h, buffering of instillation fluids containing MMC is recommended. Reuse of instilled MMC, therefore, cannot be advised.

Administration, Intravesical↗

Intravesical administration of radiolabelled tumour-associated monoclonal antibody in bladder cancer.

Considerable progress has been made over the past decade in the use of tumour-associated monoclonal antibodies (mAbs) as carriers of cytotoxic agents in the management of several malignancies. In the present study we investigated the tumour localization and biodistribution of the mAb HMFG1 to bladder cancer following intravesical administration. HMFG1, which has been raised against the polymorphic epithelial mucin (PEM), was labelled with 125I and administered intravesically 2 h and 24 h before cystoscopy. During cystoscopy, biopsies were taken from the normal bladder and the malignant lesion. Tissue samples were tested for HMFG1 immunostaining and for radioactivity with the use of a gamma-counter. The mean ratio of tumour to normal uptake for 125I-HMFG1 was 5.81 +/- 1.23, at 2 h and 2.17 +/- 0.42 at 24 h. No radioactivity was detected in the blood. We conclude that HMFG1 could be used intravesically for the successful delivery of a cytotoxic agent.

Administration, Intravesical↗

[A case of interstitial pneumonia induced by intravesical administration of bacillus Calmette-Guerin (BCG)].

A 61-year-old man with superficial bladder cancer, which was detected after he complained of hematuria, was treated three times with intravesical BCG administration. Since liver dysfunction was detected thereafter, he was admitted to our hospital. Three days after admission, he complained of dyspnea on exertion associated with severe hypoxemia, as well as abnormal findings on chest X-ray, i.e. extensive bilateral lung densities. We performed bronchoscopic examination and obtained bronchoalveolar lavage fluid (BALF) and lung biopsy specimens (TBLB). In the BALF, a marked increase in the total cell number, particularly lymphocytes with a high CD4/CD8 ratio was noted. TBLB specimens revealed the lesions to be numerous non-caseating granulomas. We failed to obtain definite evidence of BCG in the sputum, urine, blood, and BALF. Instead, we found that a lymphocyte stimulation test for BCG (DLST) was strongly positive. Based on these findings, severe interstitial pneumonia probably induced by hypersensitivity against BCG, was diagnosed. Anti-tuberculous agents, and steroid-pulse therapy followed by oral administration of relatively low dose of steroid ameliorated the abnormal conditions, including chest X-ray film findings and hypoxemia. The population of lymphocytes and CD4/CD8 ratio in the BALF were reduced as well. Serious interstitial pneumonia was induced by the intravesical administration of BCG, which resulted in transitional changes in the BALF cell component.

Administration, Intravesical↗

The role of bladder afferent pathways in bladder hyperactivity induced by the intravesical administration of nerve growth factor.

PURPOSE: Interstitial cystitis, a chronic disease of the bladder, is characterized by urinary frequency, urgency and suprapubic pain. Nerve growth factor is a substance that may sensitize afferent nerves and induce bladder hyperactivity. It is often increased in the urine of patients with interstitial cystitis. We evaluated the role of Adelta and C fiber afferents in the type of bladder hyperactivity induced by the intravesical administration of nerve growth factor. MATERIALS AND METHODS: A total of 22 Wistar and 8 Sprague-Dawley adult female rats were anesthetized with 1.2 gm/kg urethane given subcutaneously. A transurethral catheter was inserted into the bladder. Some animals were pretreated with 125 mg/kg capsaicin injected subcutaneously 4 days before nerve growth factor administration. Cystometry was performed by slowly filling the bladder at a rate of 0.04 ml per minute for 15 minutes with a volume of up to 0.6 ml. Parameters measured included volume threshold and pressure threshold for inducing the micturition reflex, compliance, bladder contraction amplitude, number of contractions and the inter-contraction interval. Nerve growth factor (0.5 ml of 20 microg/ml in 10% dimethyl sulfoxide) or a vehicle solution (0.5 ml of 10% dimethyl sulfoxide) was infused into the bladder through a transurethral catheter and retained for 1 hour. RESULTS: In Wistar rats nerve growth factor increased the mean number of contractions by 111% versus controls (5.7 versus 2.7, p <0.05), and decreased the mean volume threshold by 41% (0.244 versus 0.412 ml, p <0.05). This effect of nerve growth factor was not detected in Sprague-Dawley rats. Capsaicin pretreatment increased the volume threshold by 59% but did not change nerve growth factor induced bladder hyperactivity. CONCLUSIONS: The intravesical application of nerve growth factor acutely induced bladder hyperactivity in Wistar but not in Sprague-Dawley rats. Because the C fiber afferent neurotoxin capsaicin did not change the effect of nerve growth factor, we believe that Adelta afferent neurons have a major role in nerve growth factor induced bladder hyperactivity.

Administration, Intravesical↗

Synergistic antitumor activity by combined treatment with gemcitabine and antisense oligodeoxynucleotide targeting clusterin gene in an intravesical administration model against human bladder cancer kotcc-1 cells.

PURPOSE: We investigated whether antisense (AS) oligodeoxynucleotide (ODN) targeting the clusterin gene enhances the cytotoxic effect of gemcitabine in human bladder cancer KoTCC-1 cells in vitro and in vivo, and evaluated the usefulness of the combined administration of AS clusterin ODN and gemcitabine using an intraperitoneal tumor cell injection model. MATERIALS AND METHODS: The cytotoxic effect of combined treatment with AS clusterin ODN and gemcitabine on in vitro KoTCC-1 growth was examined using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. The in vivo growth inhibitory effects of combined AS clusterin ODN and gemcitabine therapy on subcutaneous KoTCC-1 tumor was also examined. The intraperitoneal tumor cell injection model, which mimics intravesical administration therapy against bladder cancer, was used to evaluate the efficacy of combined AS clusterin ODN and gemcitabine therapy. RESULTS: AS clusterin ODN treatment of KoTCC-1 cells significantly enhanced gemcitabine chemosensitivity in a dose dependent manner, decreasing gemcitabine IC50 by approximately 90%. In vivo systemic administration of AS clusterin ODN and gemcitabine significantly decreased subcutaneous KoTCC-1 tumor volume compared with scramble control ODN plus gemcitabine. Furthermore, combined administration of AS clusterin ODN plus gemcitabine resulted in significantly delayed formation of hemorrhagic ascites compared with scramble control ODN plus gemcitabine in an intraperitoneal tumor cell injection model. CONCLUSIONS: These findings suggest that AS clusterin ODN may be useful for enhancing the cytotoxicity of gemcitabine in patients with bladder cancer, particularly as a novel therapeutic strategy for intravesical instillation therapy.

Administration, Intravesical↗

MEN 11,420, a peptide tachykinin NK2 receptor antagonist, reduces motor responses induced by the intravesical administration of capsaicin in vivo.

This study investigates the role of tachykinin NK1 and NK2 receptors in motor responses induced by the intravesical instillation of capsaicin in urethane-anaesthetized rats. SR 140,333 (1 micromol/kg, i.v.), a nonpeptide NK1 receptor antagonist, abolished urinary bladder contractions induced by the selective NK1 receptor agonist [Sar9]SP-sulfone (0.1-100 nmol/kg, i.v.) without affecting those induced by the NK2 receptor agonist [betaAla8]NKA(4-10). MEN 11,420 (100 nmol/kg, i.v.), a cyclic peptide NK2 receptor antagonist, abolished bladder contractions induced by [betaAla8]NKA(4-10) (0.3-300 nmol/kg, i.v.) without modifying those induced by [Sar9]SP-sulfone. Intravesical instillation of capsaicin (6 nmol/0.6 ml/rat) produced a motor response consisting in a primary contraction followed by a series of high amplitude phasic contractions. The intravesical instillation of saline (0.6 ml/rat) produced a primary contraction of lower amplitude with respect to that induced by capsaicin and the total area under the curve was also lower in saline-instilled rats, however the number and the amplitude of phasic contractions was similar to that induced by capsaicin. MEN 11,420 (100 nmol/kg, i.v.) did not modify motor responses induced by the intravesical administration of saline. In contrast, in capsaicin-instilled rats, MEN 11,420 (100 nmol/kg, i.v.) reduced the primary contraction, the area under the curve and also the number of phasic contractions. SR 140,333 (1 micromol/kg, i.v.) reduced the primary contraction but not other parameters. The combination of SR 140,333 (1 micromol/kg, i.v.) and MEN 11,420 (100 nmol/kg, i.v.) produced an additive inhibitory effect on the primary contraction but not a further inhibition on other parameters with respect to that observed with MEN 11,420 alone. In hexamethonium (110 micromol/kg, i.v.)-pretreated animals the intravesical instillation of capsaicin produced a tonic contraction having greater amplitude and area than that induced by saline. MEN 11,420, but not SR 140,333, significantly reduced the bladder response to capsaicin in hexamethonium-pretreated rats. Again, the combined administration of MEN 11,420 and SR 140,333 did not produce further inhibitory effect in comparison to MEN 11,420 alone. It is concluded that the motor responses induced by the intravesical instillation of capsaicin are mediated by the activation of peripheral tachykinin NK2 receptors.

Animals↗

Intravesical administration of doxorubicin to swine bladder using magnetically targeted carriers.

PURPOSE: The feasibility of using magnetic targeted carriers (MTC) to deliver doxorubicin intravesically was studied in normal swine bladder. MTCs are microparticles consisting of metallic iron and activated carbon. Doxorubicin is adsorbed to the activated carbon component of the MTCs (MTC-DOX) while the iron component provides magnetic susceptibility. This technology is designed for site-specific delivery of a drug to a tumor in the presence of an externally applied magnetic field in order to achieve prolonged release of high localized drug concentrations by retention of MTCs in the region of interest. An intravesical route of administration was evaluated as intravesical chemotherapy is used in the treatment of bladder cancer. METHODS: The urethras of six swine were catheterized and Foley catheters were placed in their bladders. The effects of doses ranging from 10 to 80 mg doxorubicin adsorbed onto 300 to 800 mg MTCs were studied. A 30-min period of magnetic targeting immediately followed dosing, in which an external magnet was placed on the skin surface over a predetermined site on the bladder. The subsequent retention and distribution of test material was evaluated by measurement of doxorubicin levels in plasma and histopathological examination of the bladder following treatment. Blood samples were taken prior to treatment and at 15 and 30 min after infusion for measurement of doxorubicin. The bladder was drained and rinsed thoroughly following the procedure. RESULTS: Plasma doxorubicin concentrations were less than the assay limit of detection (10 ng/ml) during the 30 min following dosing. MTCs were found within the bladder walls, predominantly at the targeted site where they were present at greater depths within the layers of the epithelium. The study results show that MTC-DOX can be targeted and retained within specific locations in the bladder using magnetic targeting. CONCLUSIONS: MTC delivery may allow greater exposure and specific deposition of drug at a defined site over intravesical administration of doxorubicin alone. The feasibility of this novel method of drug delivery was demonstrated and the results support further study for its potential use in treating bladder cancer.

Animals↗

Intravesical administration of misonidazole in bladder carcinoma.

Using 11C labelled material, the diffusion of the hypoxic cell sensitizer misonidazole was tested in 19 patients with carcinoma of the bladder following its intravesical administration. Increasing concentration gradients were tested. Evidence was provided that a 20 ml solution containing 200 mmol/l of misonidazole is followed by high concentrations of the drug in the superficial as well as in deep parts of the tumour. The corresponding serum concentration was extremely low. It was concluded that this route of administration provides high local concentrations of the drug that may result in a significant therapeutic enhancement if utilized as an adjuvant to external irradiation.

Humans↗

Experimental hyperreflexia: effect of intravesical administration of various agents.

In anesthetized rabbits, we can induce a significant degree of spontaneous activity in the urinary bladder by placing a ligature around the proximal portion of the external urethra. Previous studies characterized the activity as primarily reflex in nature, since intravesical hexamethonium selectively inhibited the hyperreflexia. In this current study we determined the effect of intravesical administration of a variety of compounds to inhibit the induced hyperreflexia. The following agents were tested at concentrations of 1, 10, 100 and 500 mumol/l (intravesically): verapamil, cromakalim, nifedipine, diltiazem, and atropine; lidocaine was tested in 0.05, 0.5 and 5% solutions. The results are summarized as follows: (1) Lidocaine was the most effective agent tested, virtually eliminating both the amplitude and frequency of the spontaneous activity at the lowest concentration (0.5%). (2) Verapamil and nifedipine were somewhat more potent than cromakalim and diltiazem. Atropine sulfate was the least potent, inhibiting both the amplitude and frequency of the hyperreflexia by less than 50% at 500 mumol/l. (3) In all cases, the amplitude of the spontaneous activity was inhibited to a significantly greater degree than the frequency of the spontaneous activity. (4) In general, there was no effect of any of the agents on mean arterial pressure at 1 or 10 mumol/l. At 100 and 500 mumol/l, all agents except for lidocaine and cromakalim decreased arterial pressure. These two agents produced no consistent fall in blood pressure at any concentration. In conclusion, the acute hyperreflexic (rabbit) preparation provides a highly reproducible and consistent model for the study of the effect of drugs on hyperreflexia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Initial report on intravesical administration of N-trifluoroacetyladriamycin-14-valerate (AD 32) to patients with refractory superficial transitional cell carcinoma of the urinary bladder.

OBJECTIVES: This study was designed to assess the pharmacokinetics, safety, and antitumor activity of intravesically administered AD 32, a novel anthracycline, in patients with transitional cell carcinoma (TCC) of the bladder. METHODS: Six weekly doses of AD 32 (200 to 900 mg) were administered to 32 patients with superficial TCC who were candidates for intravesical treatment. Serum drug levels were measured during the 6-hour period after administration of the first, third, and sixth doses. Patients underwent bladder evaluations at 3-month intervals to determine responses to treatment. RESULTS: Very low levels of unmetabolized AD 32 and its two primary metabolites were measured in serum. The lack of systemic exposure was confirmed by the finding of only a few minor systemic adverse events. Local bladder irritation, the main toxicity associated with intravesical administration of AD 32, persisted for several days after each instillation. The maximum tolerated dose was 800 mg. Thirteen patients had complete responses to treatment, including 8 who remained disease free for 12.1 to 38.5 months. CONCLUSIONS: AD 32 is an active drug for the treatment of superficial bladder cancer. Further studies of intravesical administration of AD 32 are warranted.

Administration, Intravesical↗

Biosafety of in vivo adenovirus-p53 intravesical administration in mice.

OBJECTIVES: To evaluate the biosafety and in vivo biodistribution of intravesical instillation of an adenovirus that contains human p53 gene. Mutations of p53, which are found in as many as 40% of transitional cell carcinomas, are associated with a poor prognosis and resistance to chemotherapy and radiation therapy. Restoration of wild-type p53 status by means of adenoviral-mediated therapy may enhance apoptosis and improve the response to therapy, but the issues of biosafety and toxicity have not yet been addressed. METHODS: Adenovirus-p53 (1 x 10(8), 1 x 10(9), and 5 x 10(9) pfu/mL) and luciferase reporter gene (5 x 10(9)) were instilled into the bladders of anesthetized female BALB/c mice. The mice were killed on days 1, 3, 6, and 13, and representative samples of the bladder, ureter, kidney, adrenal gland, ovary, liver, heart, and lung were removed for histologic evaluation. RESULTS: No histologic signs of toxicity were found. The hematologic and biochemical profiles of the mice were normal, with the exception of a transient elevation in liver function tests on day 1 in the three treatment groups. CONCLUSIONS: Intravesical instillation of adenovirus-p53 was well tolerated; the bladder urothelium appeared to prevent systemic dissemination. The results of these experiments support the safety of intravesical gene transfer by intravesical instillation.

Adenoviridae↗

[Comparison of emepronium bromide with intravesical administration of lidocaine gel in women with urge incontinence].

In the treatment of urge incontinence, drug therapy predominates. In a prospective randomised study on treatment of females with motor urge incontinence, intravesically administered lidocaine-gel and oral emepronium bromide were compared using clinical and urodynamic parameters. From 30 patients, 15 women were treated for 3 weeks with repeated intravesical lidocaine gel instillations whilst the other 15 had a peroral emepronium bromide medication. The intravesical lidocaine gel installation proved more efficient compared with peroral emepronium bromide therapy with regard to the parameters of imperative micturition, occurrence of detrusor contractions as well as number of urinary frequencies per diem. Intravesical application of lidocaine-gel is particularly indicated in patients with increased sensitivity against parasympathicolytics and anticholinergics.

Administration, Intravesical↗