Acrolein binding (uroprotection)

A thiol decoy that meets the toxin in the urine

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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