urinary incontinence news
Vaccine for Urinary Tract Infections Shows Early Promise
September 17, 2009 -- Urinary tract infections are painful and recur all too often with no apparent cause: Ask any woman who has missed days of work due to one, or had to find emergency treatment while on vacation.
University of Michigan scientists have made an important step toward what could become the first effective vaccine to prevent urinary tract infections, if the robust immunity achieved in mice can be reproduced in humans.
The research findings, which appear online Sept. 18 in PLoS Pathogens, could have broad effects, including reduced health care costs. Urinary tract infections (UTIs) affect 53 percent of all women and 14 percent of men at least once in their lives. They lead to lost work time and 6.8 million medical provider’s office visits, 1.3 million emergency room visits and 245,000 hospitalizations a year, with an annual cost of $2.4 billion in the United States.
U-M scientists screened thousands of bacterial proteins and identified three strong candidates to use in a vaccine to prime the body to fight Escherichia coli, the cause of most uncomplicated urinary tract infections. The vaccine prevented infection and produced key types of immunity when tested in mice.
“The results of our study are very encouraging. We would like to connect with interested clinicians and move on to a clinical trial,” says Harry L. T. Mobley, Ph.D., the study’s senior author and the Frederick G. Novy Professor and chair of the U-M Department of Microbiology and Immunology.
Other scientists have attempted to develop a vaccine for UTIs over the past two decades, but U-M’s potential vaccine has several strong points that may better its chances of success where other attempts have failed:
• It alerts the immune system to iron receptors on the surface of bacteria that perform a critical function allowing infection to spread.
• Administered in the nose, it induces an immune response in the body’s mucosa, a first line of defense against invading pathogens. The response, also produced in mucosal tissue in the urinary tract, should help the body fight infection where it starts.
Context
UTIs are of particular concern for people with repeated infections who may develop resistance to antibiotics commonly used as treatment. Factors that heighten the need for a vaccine, at least for people at greater-than-average risk, include increasing antibiotic resistance, allergic reactions and the unhealthy effects of antibiotics on beneficial microorganisms in the gut. Infections in the upper urinary tract are a particular concern in children, who may be left with permanent kidney damage.
Four out of five uncomplicated urinary tract infections, the type that sickens otherwise healthy people, are caused by certain strains of E.coli capable of infecting the urinary tract. Other types of E. coli not implicated in urinary tract infections include those that cause food poisoning outbreaks, as well as beneficial ones that live in the digestive tract.
Research details
Mobley’s team used a systematic approach to look for key parts of the bacterium that could be used in a vaccine to elicit an effective immune response. They used screening methods from bioinformatics, genomics and proteomics to look for these proteins expressed by a strain of E. coli obtained from an infected patient.
“To identify candidates for the vaccine, we have used a comprehensive, unbiased approach that hasn’t been used previously,” says Christopher Alteri, Ph.D., one of the study’s first authors and a U-M research fellow in microbiology and immunology. “Also, we identified an entire class of molecules, instead of single molecules from different classes.”
The U-M researchers identified six potential vaccine candidates after screening 5,379 possible proteins. Strikingly, all six were members of a class of receptors that the bacteria use to latch onto iron in the host’s body, which they need to grow and cause infection.
Of the six proteins, three were very effective at preventing infection in mice that were immunized nasally and were then exposed to the E. coli strain. The team also tested the vaccine against another well studied strain and found it equally effective.
What’s next
Mobley’s team is currently testing more strains of E. coli obtained from women treated at U-M. Most of the strains produce the same iron-related proteins the vaccine targets, an encouraging sign that the vaccine could work against most urinary tract infections. Mobley hopes to see the vaccine move forward into a phase 1 trial in humans. If successful, the vaccine would take several more years to reach the market.
Patents/Disclosures: The U-M Office of Technology Transfer has applied for patent protection for this technology. The University is presently looking for licensing partners to help bring the technology to market.
Additional U-M authors: Erin C. Hagan, co-first author; Kelsey E. Sivick, co-first author; and Sara N. Smith
Citation: PLoS Pathogens, Sept. 18, 2009; doi:10.1371/journal.ppat.1000586
Funding: National Institutes of Health
Meditate Your Way to Better Bladder Health
May 4, 2009 — After nine years of suffering in silence and living in fear of leaving the house, Anna Raisor, 53, turned to physicians at Loyola University Health System (LUHS) for alternative measures to treat the embarrassing side effects of incontinence.
LUHS physicians enrolled Raisor in a clinical trial using cognitive therapy to manage her overactive bladder. Cognitive therapy employs deep-breathing and guided-imagery exercises that train the brain to control the bladder without medication or surgery.
Findings from this study, which were published in the latest issue of the Journal of Urology, revealed that cognitive therapy is an effective management strategy for urge incontinence.
"The mind-body connection has proven to be particularly valuable for women suffering from incontinence," said study investigator Aaron Michelfelder, MD, vice chair, division of family medicine, Loyola University Health System, and associate professor, department of family medicine, Loyola University Chicago Stritch School of Medicine. "Cognitive therapy is effective with these women, because they are motivated to make a change and regain control over their body."
Michelfelder's patients attend an initial office visit where he introduces them to cognitive therapy. They then listen to an audio recording with a series of relaxation and visualization exercises at home twice a day for two weeks. Patients track the number of incontinence episodes that they experience in a pre- and post-therapy diary. The majority of patients, including Raisor, experienced a substantial improvement in symptoms.
"Before entering this clinical trial, I saturated seven to eight pads a day and was afraid to leave home as a result," said Raisor. "Today, I am 98 percent free of leakage. The therapy has allowed me to successfully recognize the link between my brain and bladder to manage my incontinence and remain virtually accident-free."
The study evaluated a subset of 10 patients with a mean age of 62. Patients were eligible to participate in this study, if they had a diagnosis of overactive bladder (OAB), which is the sudden and unstoppable need to urinate. They also had to be stable on all OAB treatments for the past three months before entering the study. The data revealed that the average number of urge incontinence episodes per week decreased from 38 to 12.
"Nearly one in four women suffers from a pelvic floor disorder, which includes incontinence," said study investigator Mary Pat FitzGerald, MD, urogynecologist, Loyola University Health System, and associate professor of obstetrics and gynecology, Loyola University Chicago Stritch School of Medicine. "Cognitive therapy may play a vital role in a comprehensive approach to treating this disorder."
Study investigators FitzGerald and fellow Shameem Abbasy, MD, are part of a team of LUHS urogynecologists who are combining the expertise of urologists and gynecologists to transform the way women with incontinence and other pelvic floor disorders are managed. Loyola University Health System's Urogynecology and Reconstructive Pelvic Surgery Center was the first of its kind in greater Chicago. It is still one of the few centers in the country that offers a single location for the diagnosis and treatment of women with pelvic floor disorders.
In addition to using cognitive therapy to treat incontinence, LUHS urogynecologists have been using the robotic da Vinci™ surgical system with positive outcomes for nearly two years. LUHS was one of the first groups in Chicago to offer this type of minimally invasive robotic surgery.
To schedule an appointment with a LUHS physician, call (888) LUHS-888.
Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 561-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.
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