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November 9, 2011Coral Rudie, Catherine Hallet, Maria Benita
Cranberries and Urinary Tract Infections (UTIs)
Objectives
• What is a urinary tract infection
• Risk factors
• Active ingredient found in cranberries
• Mechanism of action
• Preventative effects
• Data Suggests
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
Who is Susceptible?
Women
Urinary Catheter
Suppressed Immune System
Obstruction
Inability to completely urinate
Previous UTI
Pregnancy
Treatment Prevention
• Antibiotics
• Pain Relievers
• Hospitalization
• Water
• Urinate
• Showers instead of baths
• Wipe- front to back
• Cleanse the genital area
• Cranberry Juice?
Cranberries
General Info:
• Family Ericaceae
• Vaccinium macrocarpon, • V. oxycocus • V. erythrocarpum
• Anthocyanidins and proanthocyanidins
• Natural plants defense system against microbes
Active Ingredients
A-type Proanthocyanidins (PAC)
• Raw cranberries
• Cranberry cocktails
• Cranberry juices
• Cranberry pills, capsules
Examples
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
Mechanism of Cranberry Action
Flagellin
PACs inhibit the expression of the flagellin gene (fliC)
Hidalgo G. 2011, Appl Environ Microbiol
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
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.
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.
Pros Cons
Randomized, placebo, crossover
PAC extracts Commercially available Duration Controls Varied dose exposure
Most mechanisms in vitro
Limited ability to test in vivo
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
THANK YOU
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.
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/>.
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