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Hyaluronate and risperidone for hemorrhagic cystitis

Bone Marrow Transplantation volume 39, page 57 (2007)Cite this article

In the report by Miodosky et al.,1 five of seven patients with post-hematopoietic transplantation hemorrhagic cystitis (HC) experienced complete response to intravesical sodium hyaluronate, although three patients required two instillations to achieve this. HC has been shown to be commonly associated with all the polyomaviruses.2, 3 These polyomaviruses replicate in the urinary tract4 and upregulate expression of hyaluronan in renal tubule cells.5 We hypothesize that sodium hyaluronate, apart from mechanically protecting the bladder from uroepithelial damage, alters a vital step in the life cycle of polyomaviruses. Furthermore, degradation products of hyaluronate created by urinary hyaluronidase could trigger the secretion of various cytokines and chemokines by macrophages,6 which could inhibit viral replication.

A different approach for JC virus (JCV)-related hemorrhagic cystitis involves 5-HT2a, the cell receptor required for JCV entry.7 We recently reported a dramatic clinical and virological response in a haploidentical, T-cell-depleted hematopoietic stem cell transplant recipient with biopsy-proven progressive multifocal leukoencephalopathy (another disease caused by JCV) that was treated with low doses of the high-affinity 5-HT2a antagonist risperidone.8 Risperidone has been safely used in humans over the last 20 years to treat psychiatric illness and is generally well tolerated. We also showed a 2-log reduction in JC viruria after treatment of psychiatric patients with risperidone.9

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References

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  1. D Focosi and R E Kast: These authors contributed equally to this manuscript

Authors and Affiliations

  1. Division of Hematology, Azienda Ospedaliera Santa Chiara, University of Pisa, Pisa, Italy

    D Focosi

  2. Department of Psychiatry, University of Vermont, VT, USA

    R E Kast

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  1. D Focosi
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  2. R E Kast
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Focosi, D., Kast, R. Hyaluronate and risperidone for hemorrhagic cystitis. Bone Marrow Transplant 39, 57 (2007). https://doi.org/10.1038/sj.bmt.1705546

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