A vaccine in future could cure chronic urinary tract infections
Vaccines are being developed that could train the immune system to attack bacteria that embed within the bladder wall.
Vaccines are being developed that could train the immune system to attack bacteria that embed within the bladder wall in chronic urinary tract infections, as an alliance of patients is formed to push for better diagnosis and treatment.
Millions of people around the world, predominantly women but also a proportion of men, suffer UTIs that persist for years or even decades, and many say medicine has been unable to offer a solution.
The elderly are hit particularly hard, with an estimated 10 per cent of women and 5 per cent of men aged over 65 having reported a UTI within the previous 12 months. The condition sometimes develops into sepsis and is deadly in the elderly, and can cause neurological symptoms that are often mistaken for dementia.
Acute UTIs are usually successfully treated with a single course of antibiotics, but an estimated one-in-four infections becomes chronic and for some people causes symptoms of increasing severity for years on end.
As the Australian revealed at the weekend, researchers at the The Children’s Hospital at Westmead have recently confirmed in a human tissue sample and in new microscopy techniques that in cases of recurrent infection, bacteria become embedded within the cells of the bladder wall, where they cannot be neutralised by oral antibiotics. The theory has long been accepted by leading researchers, but never demonstrated in a human and largely dismissed by doctors amid highly inaccurate mainstream diagnostic techniques that use midstream urine testing that is estimated to fail to diagnose up to 50 per cent of infections.
The Urological Society of Australian and New Zealand is now calling for an overhaul of testing and treatment protocols, but the top-level acceptance of embedded infection has left medicine with a dilemma as to how to treat the many thousands of patients suffering intractable infections amid competing concerns over antimicrobial resistance.
Some doctors are treating patients successfully with long-term high-dose antibiotics. Long-term treatment is necessary for the time it takes for the bladder cells to shed, releasing latent colonies of bugs, where they can be neutralised when free-floating in the bladder. But a treatment that avoids the negative impact of antibiotic therapy on the gut microbiome may be on the horizon.
A UTI vaccine is being developed by scientists at Duke University in the US that is administered directly into cells of the bladder wall, with an adjuvant that trains the T-cells of the immune system to fight UTI pathogens. The vaccine has been shown in animal trials to be able to fight residual bladder bacteria and may be able to also prevent future infections.
Duke University scientists, led by immunology expert and study lead Soman Abraham, discovered that following bacterial infection, the bladder evokes a vigorous T-cell response, but that response is largely directed to repairing the superficial bladder epithelium following infection-triggered exfoliation of these surface-layer cells. But the overarching focus on bladder epithelium repair by the immune system means that bladder fails to mount an antibody response to the infecting bacteria. After repeated infections the immune response becomes less effective and there are lasting changes in bladder function.
“What we have found in mice studies is that when you give them antibiotics, the antibiotics will clear almost all of the bacteria that’s in the urine, and on the surface of the epithelial cells lining the bladder, but the bacteria hiding within the epithelial cells are protected from the antibiotics. And they can persist for long periods,” Professor Abraham said.
“With this vaccine we believe that we can deliver the remedy to the very site that we need to, and educate the immune system on where to target the T-cells to fight the infection.”
Patient groups from the US, Britain and Australia have formed the Global UTI Project, which has launched an international study to ascertain and document the prevalence of chronic UTI and severity of symptoms around the world.
More Coverage
NASA upgrades risk of ‘city-killer’ asteroid hitting earth
The threat level of asteroids usually goes down with time, however the danger posed by 2024 YR4 has been increasing since it was discovered in December.
‘Confronting, tough’ decision to euthanise 90 whales
Attempts to rescue 90 surviving false killer whales stranded on a remote Tasmanian beach have failed, forcing authorities to make ‘tough, confronting’ choices.