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/>.