Findings from the Male Urethral Microbiome Project

Barbara Van Der Pol, PhD, MPH Barbara Van Der Pol, PhD, MPH (HPER)(HPER)David E Nelson, PhD (Biology)David E Nelson, PhD (Biology)

Urethritis

•Inflammatory response in the urethra causing discharge, pain on urination and burning/itching

•Leading cause of male healthcare office visits in US▫69.5% of initial visits in Massachusetts HMO*

<20% had identifiable infection

*Ratelle, et al STD 2001

What causes urethritis?Pathogens? Host Response?

Collaboration is Essential

•Clinical/Epidemiologic questions▫Why are some men at greater risk of

urethritis?▫How does this impact STI control efforts?▫Need patient samples and data

•Molecular tools provide answers▫What microbial communities are related to

these syndromes?▫How can we identify & quantify them?

Methods•Enrolled men from STD clinic population

▫Collected paired samples, behavioral data, sexual history, urethral health and prostatitis history

▫Ran STD diagnostic assays•Samples sent in nucleic acid preservative to

Dave Nelson’s lab▫DNA isolated/quantified▫PCR amplified using broad-range 16S primers▫Deep pyrosequenced specimens at the IU

CGB▫Analysis

Bacterial identification: 16S rRNA

Nelson et al, 2010 PloS One

What we found in adult men

What is Urine Measuring?

•Bladder•Urethra•External penis

•Hypothesis: Urine predominately samples the urethra

Urine versus Swab

Which would YOU choose?

PloS One in press

Profile of the Communities in Men w/ STI

Profile of the Communities in Men w/o STI

Urine and Swab samples give similar results on an individual level

•The closest match of most individual urine or swab specimens was usually the corresponding specimen

•Of the 22 specimen pairs from STI negative men, only two differed by Kolmogorov-Smirnov test ▫subject#15, p=0.0497 ▫subject #26, p=0.0246

Heat Map of Patterns from Men w/ & w/o STI

Urine and Swab samples give similar results on an individual level

•Clustering analysis indicated that the two specimens from subject 15 were more similar to each other than to all other specimens in the group of healthy men

“Vagina Monlogues” Redux

H+H+ H+

L. crispatus N. gonnorhoeae

Applying what we have learned

•Have demonstrated utility of urine sampling

•Have shown differences among men based on STI status

•Have identified further differences among men WITH urethritis

•Have begun to identify pathogens similar to those seen in vaginal syndromes

•Have begun longitudinal analysis of microbiome in young men

A good investment?• UH3 funded (Aug 2010-2013, $5.4 million

TC)• Manuscripts:

▫ Preliminary exploration of male urethral microbiome (PLoS One Dec, 2010)

▫ Comparison of urethral swabs to urine (PloS One in press)▫ Unique composition of microbiome in urethritis related to

STI (in prep)▫ Baseline analysis of young men: differences based on sexual

behavior & circumcision status (in prep)• Presentations:

▫ NIH Human Microbiome Symposium 2011 [3 posters, 1 oral presentation]

▫ ISSTDR London [1 poster, 1 oral presentation]▫ Midwest Microbial Pathogenesis Conference [1 poster]

Summary

Thanks!

•CTSI PDT•JD Fortenberry (IU Adolescent Medicine)•Q Dong (UNT Bioinformatics)•BP Katz (IU Biostatistics)•Evelyn Toh (IU Biology)•George Weinstock (WUStL Genomics)