In August, the Howell Foundation hosted Dr. Linda Brubaker, a board-certified urogynecologist who specializes in treating adult women with recurrent urinary tract infections. Dr. Brubaker is Clinical Professor, Reproductive Medicine, Obstetrics and Gynecology at the School of Health Sciences at UCSD.
After 30 years of practice, Dr. Brubaker decided to focus her research on the causes and therapies for recurring urinary tract infections. Her presentation “Urine Trouble: Women’s Bladder Health and the Urinary Microbiome” explained the facts about the conditions that lead to a urinary tract infection and new treatment being developed.
“It [recurring urinary tract infection] is a very humiliating and disruptive condition, even though it’s often treatable, always manageable and frequently curable. Urinary health has received very little attention. It’s not so sexy like cancer or heart disease, but it affects the tremendous number of women.”
The main takeaways of her presentation are:
The Backgound
According to Dr. Brubaker, urinary tract infections (UTI) affect half of women at least once in their lifetime. Women are more likely to have a second UTI after they’ve had the first one. A subset of women, about 2%-5%, present frequent or recurring infections. The most common way to treat a urinary tract infection is with antibiotics, even though the collateral effects include disturbing other microbiomes in our body.
“Patients who have recurrent urinary tract infections don’t have good care in America or any place in the world. And so when I retired from surgery, I made it my clinical focus to work in this area to see if I could make some improvements for women with recurrent or frequent urinary tract infections.”
The Bladder is NOT sterile
While for decades it was assumed that the bladder was a totally sterile environment, recent research has shown the contrary: the bladder is NOT a sterile organ. Furthermore, the bacteria in neighboring organs to the bladder may play a significant role in healthy or unhealthy bacteria in the bladder’s urobiome. As an example, an unhealthy bowel will affect the bacteria in our vagina, and subsequently, affect the bacteria in our bladders.
“You can actually eat your way to really good health and you can eat your prebiotics and probiotics. And that’s far preferable to the unproven wild west of probiotic supplements. So eat dark leafy greens, fresh vegetables, and when you can afford it and it’s appropriate for your household, try to go organic.”
The testing
Current testing to determine healthy and unhealthy bacteria is obsolete. Yet the testing technology that was developed in the 1950’s to determine unhealthy bacteria that cause urinary tract infections is still used today. Traditional methods of testing account for only 2% of the unhealthy bacteria the bladder –the most common one being E-Coli; missing the other 98% of the microbiome in our bladders.
The best way to determine healthy bacteria is based on culture independent techniques, or sequencing.
“We preserve and extract the DNA from urine. We’re interested in the bacterial, the fungal and the viral cells. We use a portion of their DNA and RNA and we sequence it, determining the exact organization of the DNA. Each sequence is different, and no result is the same.
Everybody’s urobiome is “reproducible”. Expanded culture techniques allow the appropriate conditions to cultivate the bacteria picked up on sequencing, and identifies some or all of that 98% of missed bacteria. Through statistical and bio-informatic testing the results will determine healthy vs. unhealthy bacteria.”
By turning the urine into a set of data, a specific algorithm can allow the detection of the unhealthy responsible for that causes a UTI.
The state of the bladder’s bacterial community
A recurring urinary tract infection typically occurs when a healthy bacterial community –biosis—becomes dysbiotic – or unbalanced. Even though a healthy biosis is not the same every day, this bacterial community regulates itself. When that bacterial community is dysbiotic, it can’t regulate itself back into a healthy state.
“Women’s urinary biome plays a significant role in [recurring] UTI’s. The bacterial community in the urobiome is generally beneficial, and holds lactobacillus that live in the bladder that are different from the lactobacillus that live in the vagina. Lactobacillus is generally very friendly. A UTI is not just a matter of having a bad bacteria. Vulnerability to UTI can also be due to the loss of good bacteria, which is why we try not to overdo it with the antibiotics.”
Identifying and understanding the levels of healthy or unhealthy bacteria helps predict the responses of medication – typically antibiotics, and typically effective about half the time. This is important because the development of antibiotic resistance and drug side effects has made it difficult to find an effective treatment. It is estimated that 10,000 people die per year because of antibiotic-resistant bacteria.
Getting a better response to medication is a priority for Dr. Brubaker.
New Research for new treatment of recurring urinary tract infections.
There are two factors to consider when discussing treatment for a UTI:
- The fact that intracellular bacteria hides in the walls of the bladder, making it difficult for antibiotics to clear the infection.
- Bacteria can also hide the organ’s biofilm, which contains about 10 times more bacterial cells. This bacterial biofilm also contains viruses that may infect healthy bacteria.
Based on this, Dr. Brubaker is researching phage therapy as a new alternative to treat severe and recurring urinary tract infections. Still in its infancy, the use of bacteriophages to treat bacterial infections could be used as an alternative to antibiotics when bacteria are immune to multiple types of drugs, especially at a time where superbugs are becoming a concern with the more frequent use of antibiotics.
This is an excellent example about the impact phage therapy is starting to have in the medical community; especially in an era where a patient’s health is at risk (of even death) from the overuse of antibiotics. The dedication of researchers like Dr. Brubaker are leading the way into a new era of medicine.
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The Doris A. Howell Foundation for Women’s Health Research has been dedicated to keeping the women we love healthy by making a long-term, positive impact on women’s health. It is the premier organization advancing women’s health.
The organization does so by:
- Awarding undergraduate research scholarships and graduate nursing research grants to scientists researching issues affecting women’s health;
- Presenting the latest medical research findings at our events and t hrough our Speaker Service progam, where experts and researchers convey timely timely information on topics relevant to women’s health and the health of their families,
- Funding research initiatives geared towards improving the health of under-served women and increase awareness and advocacy in the community; bringing women’s health research to a full cycle.
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