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

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 o Urine is sterile o Bacteria (e.coli) Symptoms o Urgency to urinate o Burn/pain on urination o 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. Anthocyanidins and proanthocyanidins Natural plants defense system against microbes Active Ingredients

8. A-type Proanthocyanidins (PAC)

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

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 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

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. cranberry-infocenter.ch/m/mandanten/188/download/PACs_QA.pdf "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..