Mesenchymal stromal cell therapy is a long-term regenerative approach for chronic radiation cystitis, involving coordinated modulation of the urothelial, immune, vascular, and fibrotic pathways.

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Chronic radiation cystitis (CRC) is a disabling late adverse effect of pelvic irradiation, characterized by urothelial barrier loss, persistent inflammation, vascular alteration, and progressive fibrosis. No curative treatment exists. Mesenchymal stromal cells (MSCs) are investigated for their regenerative potential, however their long-term mechanisms of action in CRC remain incompletely elucidated. CRC was induced in rats by localized bladder irradiation (40 Gy). Animals were randomized into unirradiated controls, irradiated controls, and irradiated MSC-treated groups. The treated group received three intravenous injections of adipose-derived MSCs at 4.5, 5.0, and 5.5 months post-irradiation, during the pre-chronic phase. Bladders were analyzed up to 18 months post-irradiation by immunostaining and RT-qPCR for urothelial differentiation (Upk1a, Upk1b, Upk2, Upk3a, Upk3b), epithelial proliferation (CK14⁺/PCNA⁺) and fibrosis (collagen I and III). Immune activation (CD45⁺ leukocytes, neutrophils, mast cells, Gata3, Th1, Th2) was analyzed by flow cytometry and vascular integrity by cystoscopy and Cspg4, VegfA expression. At 18 months post-irradiation, irradiated bladders showed a 90% loss of UPK3 staining and hyperplasia (urothelium thickening) greater than 300 μm result of basal cell hyperproliferation, a ninefold increase compared to controls. MSC treatment reduced hyperplasia b

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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