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/>.