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Cranberries and Urinary Tract Infections (UTIs)

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.

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Cranberries and Urinary Tract Infections (UTIs)

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  1. Cranberries and Urinary Tract Infections (UTIs) November 9, 2011 Coral Rudie, Catherine Hallet, Maria Benita

  2. Objectives • What is a urinary tract infection • Risk factors • Active ingredient found in cranberries • Mechanism of action • Preventative effects • Data Suggests

  3. Urinary Tract Infections (UTI) • What is a UTI?     "Any infection of any of the organs of the urinary system" • Cause • Urine is sterile • Bacteria (e.coli) • Symptoms • Urgency to urinate • Burn/pain on urination • Blood or pus in urine

  4. Who is Susceptible? Women Urinary Catheter Suppressed Immune System Obstruction Inability to completely urinate Previous UTI Pregnancy

  5. Treatment                   Prevention • Antibiotics • Pain Relievers • Hospitalization • Water  • Urinate • Showers instead of baths • Wipe- front to back • Cleanse the genital area • Cranberry                  Juice?

  6. Cranberries General Info: • Family Ericaceae • Vaccinium macrocarpon, • V. oxycocus • V. erythrocarpum

  7. Active Ingredients • Anthocyanidins and proanthocyanidins • Natural plants defense system against microbes

  8. A-type Proanthocyanidins (PAC)

  9. Examples • Raw cranberries  • Cranberry cocktails • Cranberry juices • Cranberry pills, capsules

  10. 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

  11. Mechanism of Cranberry Action Flagellin • PACs inhibit the expression of the flagellin gene (fliC) Hidalgo G. 2011, Appl Environ Microbiol

  12. 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

  13. 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.

  14. 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.

  15. Pros Cons • Randomized, placebo, crossover • PAC extracts • Commercially available • Duration • Controls • Varied dose exposure • Most mechanisms in vitro • Limited ability to test in vivo

  16. 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 • One eight-ounce glass of cranberry juice cocktail contains just as many PACs as • 1/4 cup of fresh or frozen cranberries •  12 Kcals • 1/3 cup of sweetened dried cranberries •  138 Kcals • 1/3 cup of cranberry sauce. •  145 Kcals

  17. THANK YOU

  18. 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.

  19. 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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