THE EFFECTS OF INTRAVESICAL PRETREATMENT WITH PENTOSAN POLYSULFATE ONTHE BACILLUS-CALMETTE-GUERIN INDUCED IMMUNE-REACTION OF THE GUINEA-PIG

Immunotherapy with intravesical instillation of bacillus Calmette-Guer in (BCG) is an effective treatment for superficial bladder carcinoma. In the present study the BCG-induced immunological reaction in the gui nea pig (PPD skin test, bladder wall infiltrates and number of cells i n the iliac lymph nodes) was investigated after intravesical pretreatm ent with pentosan polysulphate (PPS), which modulated BCG attachment t o the bladder wall. Pentosan polysulfate is a molecule comparable to t he naturally occurring glycosaminoglycans (GAGs) of the bladder mucosa . The data obtained after six weekly instillations of BCG-RIVM (5 x 10 (6) - 5 x 10(7) cfu) with or without preinstillation with PPS (10 mg. in 1 ml. for 0.5 hour) suggested an elevation of the immunological rea ction to intravesical BCG. A strong binding capacity of PPS to the mam malian bladder wall was observed. In addition, and in contrast to bact eria commonly causing cystitis, a significant binding of PPS to mycoba cteria was found: 3.5, 3.6 and 3.1 mu g./ml. dry weight of BCG Connaug ht, RIVM and Pasteur, compared with 0.2, 0.3, 0.7 and 0.0 mu/mg. dry w eight of Escherichia coli, Streptococcus faecalis, Klebsiella pneumoni ae and Proteus. The results suggest that PPS enhances the attachment o f BCG to the bladder wall, resulting in an increased BCG-induced immun ological reaction in the guinea pig. It may be speculated that pretrea tment with PPS may increase the efficacy of BCG therapy in man, especi ally in those patients not exhibiting an immunological reaction.