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Cranberries and Urinary Tract
Infections (UTIs)
November 9, 2011
Coral Rudie, Catherine Hallet, Maria Benita
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"
•
Cause
o Urine is sterile
o Bacteria (e.coli)
•
Symptoms
o Urgency to urinate
o Burn/pain on urination
o Blood or pus in urine
Who is Susceptible?
Women
Urinary Catheter
Suppressed Immune System
Obstruction
Inability to completely urinate
Previous UTI
Pregnancy
Treatment
•
•
•
Antibiotics
Pain Relievers
Hospitalization
Prevention
•
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
•
•
Active Ingredients
• Anthocyanidins and
proanthocyanidins
• Natural plants defense system
against microbes
A-type Proanthocyanidins (PAC)
Examples
• Raw cranberries
• Cranberry cocktails
• Cranberry juices
• Cranberry pills, capsules
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
Dose and Time Dependent
•
Linear increase in urinary antiadhesion activity
•
36 mg of cranberry PAC
equivalents per day is effective
Howell AB. 2010, BMC Infect Dis.
Cranberries vs. Antibiotics
vs.
•
Results indicated that antibiotics are more effective in
preventing UTI
•
But are antibiotics really needed?
Mariëlle A. J. Beerepoot, MD. 2011, Arch Intern Med.
Pros
Randomized, placebo,
crossover
PAC extracts
Commercially available
Duration
Controls
Varied dose exposure
Cons
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 as
o 1/4 cup of fresh or frozen cranberries
o 12 Kcals
o 1/3 cup of sweetened dried cranberries
o 138 Kcals
o 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/>.