The Immunomodulatory Imbalance in Patients with Ketamine Cystitis

Thepathogenesis of ketamine cystitis (KC) has been recently linked with immune response to patients but the same has not yet been established. Hence, this study aims to propose a possible immune mechanism of irreversible bladder damage caused by KC. A total of 53 KC patients and 21 healthy volunteers as controls have been retrospectively assessed. The levels of serum immunoglobulin E (IgE), IL-6, and IFN-gamma of KC patients were significantly higher than those of controls, whereas the TGF-beta levels of KC patients substantially reduced but the IL-2 and IL-4 levels of KC patients were comparable to those of controls. Moreover, the KC patients had significantly higher counts of T(H)1, T(H)2, and T(H)17 cells than those of controls. The immune response of KC users may begin with the IL-6 production and differentiation of T(H)17 and may be followed by alternating between high expressions of T(H)1 and T(H)2. The IL-6 may further suppress the T-REG cells which can aggravate chronic inflammation in KC patients and the imbalance in T(H)17 and TREG cells may involve the pathogenesis of KC. Further investigation is needed to define the role of IL-6 in T(H)1/T(H)2/T(H)17-regulated signaling pathway in ketamine-induced cystitis.