GAG for FLUTD?
The cause of feline interstitial cystitis (FIC) is not well understood. Suggested treatments for FIC and feline idiopathic lower urinary tract disease (iFLUTD) include several environmental and dietary modifications, as well as pharmacologic interventions.One of these, glycosaminoglycan (GAG) replacement therapy,was recently studied in a double-blind clinical trial.The researchers evaluated the efficacy of pentosan polysulfate (PPS), a semisynthetic GAG, for the treatment of iFLUTD in cats. Eighteen cats were randomly assigned to receive subcutaneous injections of PPS, 3 mg/kg (n = 9), or placebo (isotonic saline solution) (n = 9). Injections were given on days 1, 2, 5, and 10. The cats were clinically evaluated at the time of injections, and owners were interviewed about the cats’ urination habits.Telephone interviews of owners were conducted at 2 weeks, 2 and 6 months, and 1 year after initiating treatment. Fifteen cats were treated with all 4 injections, 2 cats received 3 injections (placebo), and 1 cat received 2 injections (PPS). Clinical signs recurred in 5 cats (27%) during the study period; only 1 of these had more than 1 episode.On reevaluation, the 2 groups did not significantly differ.The study suggests that most cats (89%) with iFLUTD will have spontaneous resolution of signs and that frequency of recurrent signs is low. PPS could not be recommended for use in iFLUTD on the basis of the results, although the study could not evaluate possible beneficial effects in cats with continuous or frequently recurrent clinical signs.
COMMENTARY: Urinary glycosaminoglycan (GAG) concentrations are lower in some cats with obstructive and nonobstructive lower urinary tract disease than concentrations in normal adult cats. Since GAGs may protect bladder urothelium from bacterial and microcrystal adherence, it has been postulated that feline interstitial cystitis patients might have a defective GAG layer and that providing exogenous GAGs may help prevent the recurrence of clinical signs.The current study, long overdue, tests this hypothesis in a well-designed clinical trial with 1 year follow-up performed in a large private veterinary hospital.The results do not support the parenteral administration of GAGs to cats with signs of feline interstitial cystitis for this purpose.
Use of pentosan polysulphate in cats with idiopathic, non-obstructive lower urinary tract disease:A double-blind, randomized, placebo-controlled trial.Wallius BM,Tidholm AE. J FELINEMED SURG 11:409-412, 2009.