PD20-10 PROSPECTIVE, MULTICENTER, RANDOMIZED CLINICAL TRIAL COMPARING THE EFFECT OF HYDRODISTENTION AND TRANSURTHRAL FULGURATION OF BLADDER IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS

INTRODUCTION AND OBJECTIVES: Chronic pelvic pain afflicts millions of patients in the U.S., yet underlying disease mechanisms remain unclear. We recently reported that E. coli strains exhibit diverse pain phenotypes in a murine urinary tract infection model that were subject to modulation via the GI tract, including a chronic pelvic pain phenotype reminiscent of interstitial cystitis/bladder pain syndrome (IC). Thus, we hypothesized that flora of the GI and/or reproductive tracts modulate IC symptoms and characterized the IC microbiome. METHODS: The NIDDK-sponsored Multi-Disciplinary Approaches toChronicPelvicPainNetwork (MAPP) isacomprehensiveeffort to characterize IC and other chronic pelvic pain syndromes. Female IC patients and controls were recruited into this study from individuals already participating in MAPP at Northwestern University for analyses of fecal and vaginal flora, and a second cohort was recruited that included non-MAPP participants. Stool and vaginal swabs from the introitus, mid-vagina, and posterior fornix were obtained and processed according to the Human Microbiome Project Manual of Procedures. Duplicate samples were cultured under anaerobic conditions. Purified DNA samples were subjected to 16S rDNA sequence and metagenome sequence analyses. RESULTS: Random forest analyses identified statistically significant features that discriminated IC patients from controls. Consistent with differences in microbiomes, oral gavage of anaerobic cultures from IC patients and controls into mice differentially modulated pelvic pain. CONCLUSIONS: These preliminary studies suggest that chronic pelvic pain is associated with an altered fecal microbiome in IC patients. Moreover, specific taxa may modulate IC symptoms and represent novel biomarkers for diagnosis.