november 9, 2011 coral rudie, catherine hallet, maria benita cranberries and urinary tract...
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November 9, 2011Coral Rudie, Catherine Hallet, Maria Benita
Cranberries and Urinary Tract Infections (UTIs)
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Objectives
• What is a urinary tract infection
• Risk factors
• Active ingredient found in cranberries
• Mechanism of action
• Preventative effects
• Data Suggests
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Urinary Tract Infections (UTI)
• What is a UTI?
"Any infection of any of the organs of the urinary system"
• Causeo Urine is sterileo Bacteria (e.coli)
• Symptomso Urgency to urinateo Burn/pain on urinationo Blood or pus in urine
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Who is Susceptible?
Women
Urinary Catheter
Suppressed Immune System
Obstruction
Inability to completely urinate
Previous UTI
Pregnancy
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Treatment Prevention
• Antibiotics
• Pain Relievers
• Hospitalization
• Water
• Urinate
• Showers instead of baths
• Wipe- front to back
• Cleanse the genital area
• Cranberry Juice?
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Cranberries
General Info:
• Family Ericaceae
• Vaccinium macrocarpon, • V. oxycocus • V. erythrocarpum
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• Anthocyanidins and proanthocyanidins
• Natural plants defense system against microbes
Active Ingredients
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A-type Proanthocyanidins (PAC)
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• Raw cranberries
• Cranberry cocktails
• Cranberry juices
• Cranberry pills, capsules
Examples
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Mechanism of Cranberry Action
P-fimbriae: Pilus
• PACs modifies the structure of the pilus and inhibits bacterial adherence to uroepithelial cells
Gupta A et al. 2011, Urological Research
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Mechanism of Cranberry Action
Flagellin
PACs inhibit the expression of the flagellin gene (fliC)
Hidalgo G. 2011, Appl Environ Microbiol
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Greater Concentration Increases Protection
• Bioactivity of the proanthocyanidin was detected at concentrations of 10–50 μg/ml with significant bacteriuria.
• Anti-adherence property was exhibited with multi-drug resistant strains of uropathogenic P-fimbriated E. coli
Gupta et al. 2011, Urological Research
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Dose and Time Dependent
• Linear increase in urinary anti-
adhesion activity
• 36 mg of cranberry PAC equivalents per day is effective
Howell AB. 2010, BMC Infect Dis.
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Cranberries vs. Antibiotics
• Results indicated that antibiotics are more effective in preventing UTI
• But are antibiotics really needed?
vs.
Mariëlle A. J. Beerepoot, MD. 2011, Arch Intern Med.
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Pros Cons
Randomized, placebo, crossover
PAC extracts Commercially available Duration Controls Varied dose exposure
Most mechanisms in vitro
Limited ability to test in vivo
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Data Suggests
• Clinical research on prevention of UTIs suggests 8-10 ounces of cranberry juice cocktail is effective.
Ocean Spray Cranberry Juice Cocktail 1 Cup = 130 Kcals
o One eight-ounce glass of cranberry juice cocktail contains just as many PACs aso 1/4 cup of fresh or frozen cranberries
o 12 Kcalso 1/3 cup of sweetened dried cranberries
o 138 Kcalso 1/3 cup of cranberry sauce.
o 145 Kcals
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THANK YOU
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References
Gupta A, Dwivedi M, Mahdi AA, Nagana Gowda GA, Khetrapal CL, Bhandari M (2011) Inhibition of adherence of multi-drug resistant E. coli by proanthocyanidin. Urol Res.
Hidalgo G, Chan M, Tufenkji N (2011) Inhibition of Escherichia coli CFT073 fliC expression and motility by cranberry materials.Appl Environ Microbiol 77(19):6852-7.
Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, Tenke P, Sotto A, Lavigne JP (2010) Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis 10:94.
Mariëlle A. J. Beerepoot, MD; Gerben ter Riet, MD, PhD; Sita Nys, PhD; Willem M. van der Wal, MSc; Corianne A. J. M. de Borgie, PhD; Theo M. de Reijke, MD, PhD; Jan M. Prins, MD, PhD; Jeanne Koeijers, MD; Annelies Verbon, MD, PhD; Ellen Stobberingh, PhD; Suzanne E. Geerlings, MD, PhD (2011) Cranberries vs Antibiotics to Prevent Urinary Tract Infections: A Randomized Double-blind Noninferiority Trial in Premenopausal Women. Arch Intern Med 171(14):1270-1278.
Paola A. Pinzón-Arango, Yatao Liu, and Terri A. Camesano (2009) Role of Cranberry on Bacterial Adhesion Forces and Implications for Escherichia coli–Uroepithelial Cell Attachment. J Med Food 12(2):259–270.
Ronald A (2003) The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon 49(2):71–82.
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References
Cranberry Proanthocyanidins (PACs): Facts for Media.cranberry-infocenter.ch/m/mandanten/188/download/PACs_QA.pdf Accessed on Oct 20, 2011.
"Urinary Tract Infections in Adults - National Kidney and Urologic Diseases Information Clearinghouse." Home Page - National Kidney and Urologic Diseases Information Clearinghouse. Web. 02 Nov. 2011. <http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/>.