Acrolein binding (uroprotection)
A thiol decoy that meets the toxin in the urine
- Thiol donor binds acrolein, the bladder-toxic metabolite of cyclophosphamide/ifosfamide
- Neutralizes acrolein in the urinary tract → prevents hemorrhagic cystitis
- Acts in urine without affecting the antitumor effect
- Ifosfamide/cyclophosphamide → acrolein, concentrated in bladder urine → hemorrhagic cystitis
- Free thiol binds acrolein into an inert thioether; protection happens IN THE BLADDER, not the blood
- ➔ mesna (MESNEX) — 2-mercaptoethanesulfonate
- Timed to the oxazaphosphorine doses (0, 4, 8 h); protects the bladder only — no effect on efficacy or myelosuppression
Drugs with this mechanism (1)
- Mesna — Acrolein scavenger that protects the bladder during ifosfamide or cyclophosphamide treatment.
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