New ICA newsletter discusses bacteria at length

[ISONormal]

It's fascinating. They feature one researcher whose team has looked at how bacteria actually latch onto the bladder lining and create a pod then grow inside that, hidden from antibiotics. They are working on ways to stop those little things from attaching in the first place. You've got to read it. It's so cool. The whole newsletter is packed with recent research information and I noticed that it would answer tons of questions and issues that we all raise on this board, about every subject under the IC sun. The future looks EXCITING for IC patients!!!!! :)

:) :woohoo: :)

[Katrina]

which one...February 06???? What is the tittle?

[Katrina]

http://www.ichelp.org/cafeica/Vol06No01.html#4.

Could Viruses Play a Role in IC?
Fioriti D, Penta M, Mischitelli M, Degener AM, Pierangeli A, Gentile V, Nicosia R, Gallinelli C, Chiarini F, Pietropaolo V. Interstitial cystitis and infectious agents. Int J Immunopathol Pharmacol. 2005 Oct-Dec;18(4):799-804.

These Italian researchers looked for evidence of various bacteria and viruses in a biopsy specimen from an IC patient. They found the genetic material of human polyoma virus BK (BKV) and human papilloma virus 66 (HPV-66). The researchers did not find evidence of herpes virus type 1 and 2, adenovirus, or of two types of bacteria, Chlamydia trachomatis and Mycoplasma genitalium. The researchers speculated that co-infection with a virus might play a role in IC. (BKV is very commonly found in human serum and is known to stay dormant in the urinary tract. It has been linked to hemorrhagic cystitis and nephritis. HPV-66 is one of the types of human papilloma virus that may cause cervical cancer.)

[ISONormal]

Actually, it's their printed newsletter, rather than the Cafe ICA that they email out. So it's much longer with a lot more information. If I get a chance later, I'll try to put in more info from it.

[ihurttoo]

Actually, it's their printed newsletter, rather than the Cafe ICA that they email out. So it's much longer with a lot more information. If I get a chance later, I'll try to put in more info from it.
I know I am asking alot, but if you can find the time, I, (and I am sure many others here), would love it if you could post some of the article you read. It sounds really fascinating. Again, I know I am asking for an awful lot, so if it would be too much trouble, I understand. However, if you dont mind, I would really love to hear more! Thank you in advance if you are able to do that! Hugs, Amy (P.S. I have been meaning to tell you that I always love your posts so much! It's kind of like when I read the newspaper, I always go to the Obits and Dear Abby first. Well, on here, you are my Dear Abby and Obits!! LOL! I always want to read your stuff first!) (Bet nobody's ever compared you with the obituaries before! LOL! :biglaugh: )

[ISONormal]

Amy, you are such a flatterer! The obits! It's true, though. They sure are interesting. I like the classified ads, too. :) Okay, I can't resist, and besides, you all are worth it!

The article is entitled "Innovative Research Points to New Explanation for Recurring UTIs”

“When women experience recurrent UTIs, it may not be because they get reinfected. Instead, the bacteria may hide out in the bladder lining, cloaking themselves from the immune system and even antibiotics and coming out of hiding to cause symptoms another day.”

“The research that has demonstrated these bacterial tactics in mouse bladders could bring new treatments that would be a boon to IC patients who get recurrent UTIs as well as women without IC who experience recurrent UTIs. Instead of antibiotics, which seem to cause flares for some IC patients, new treatments might keep the bacteria from attaching to the bladder lining in the first place or teach the body’s immune system to destroy the bacteria that have this potential.”

It may also meant that recurrent infections aren’t’ your “fault” because of poor hygiene. Most UTIs are caused by E coli bacteria, which normally live in the bowel. The usual hygiene recommendations, such as wiping front to back, voiding before and after sex, and drinking enough fluids, are aimed at keeping those bacteria from entering your urinary tract or flushing them out before they can cause problems. Those habits are still good ones to have, but this research implies that recurrent infection isn’t because you just weren’t diligent enough about hygiene.

The new ideas are emerging from the laboratory of Scott Hultgren, PhD, at the Washington University School of Medicine in MO. In his research, he found that to cause an infection, E coli have to have hair-like structures on their surface, called pili. These pili allow the bacteria to latch on to the cells on the bladder lining’s surface, and Dr. Hultgren and his team have found out how. The pili contain a substance, called mannose-binding adhesin, which latches on to specific proteins on the bladder surface cells. Then, the bacteria can invade the cells.

Amazing time lapse videomicrography [the include pictures of this; it’s so cool] developed at the Stanford University School of Medicine, has allowed Dr. Hultgren and his team to see exactly what the bacteria do after that. Once inside a bladder surface cell, they multiply and form a biofilm-like community of cells that fill up most of the bladder cell. This film can protect them from the immune system and antibiotics. The colony of bacteria expands into the bladder cavity, looking like a pod.

Bacteria at the edge of the pod then escape into the bladder and attach to other surface cells and start the cycle again.

Eventually, the cycle slows down until there are only small clusters of bacteria that don’t multiply but sit there, sometimes for months. Once they are reactivated, though, the UTI recurs. As Hultgren and his team put it, the infectious E coli “cleverly usurps the bladder and uses it as both a culture tube and a hiding place.”

Research on how the bacterial pili form could lead to new alternatives to antibiotics for stopping UTIs. Compared with antibiotics, they could be more effective, get around the problem of bacterial resistance, and be easier on patients. We should learn more about “pilicides” soon because Dr. Hultgren and his team are working with Fredrik Almqvist, PhD, at Umea University in Sweden, who has already developed some compounds that seem to block pili formation.

In addition, the research might lead to a vaccine to prevent UTIs altogether if researchers find that people can develop antibodies to the substances that are required for pili to form.

Soon, the research on recurrent UTIs will go beyond mice and monkeys to real women. They will be studying women who get recurrent UTIs to find out whether there is a relationship in time between colonization of the vagina by a UTI-causing bacteria and a later UTI or between bacteria in the urine that don’t cause symptoms and a later UTI. The researchers will also look for bacteria that might persist in the women’s bladders after a UTI and determine whether those same bacteria cause subsequent UTIs. Dr. Hultgren and his team will look at the bacteria from the women in the study to identify the genes that may be responsible for making some bacteria bad actors or keeping others benign.

THE END

Cool, huh? There were 3 photos, too, of 1) a bacteria attaching, 2) pod formation, and 3) pod shedding. Weird.

What do you think???

[ihurttoo]

WOW!!! Now that's what I call service. And FAST too!! I am impressed! Too bad you dont work in my dr's office! LOL!
The article is very interesting! I can see why you were intrigued by it. I find this sort of thing extremely fascinating!
I am one of the few ICers that actually get "real" UTIs. I had 10 of them documented last year alone. It seemed as though I was on antibiotics all year! Then when I get a UTI, and take the antibiotics, the yeast follows. Then I have to go on Diflucan, Then when the constipation comes, I have to take stool softners. Then when the Diflucan causes nausea, I have to take Phenegrin. It is just a never ending battle, and one problem causes another.
I would be so grateful if they really could come up with a vaccine for UTIs. WOW! I felt like I was peering into the future when I read this. I just hope that it comes to fruition.
Thank you again for posting this for us. I know that was alot of work. I just want to say thank you and that we appreciate it very much! Hugs, Amy

[Martha13]

That was a good article. The concept of E. coli forming biofilms or "pods" was first publicized several years ago when Dr. Hultgren first discovered them. He was the featured speaker at the NIH symposium part of the ICA conference held in Alexandria, VA in 2003. ICN Jill heard him speak and was very impressed. Here is a website describing the work of his lab:

http://www.hultgrenlab.wustl.edu/research_UTI_path.html

The topic of biofilms is hot right now among those doing bacterial research. They have also found Enterococci form biofilms in research conducted in Japan:

http://www.lib.okayama-u.ac.jp/www/acta/pdf/59_3_79.pdf

Hultgren's lab also has done research into enterococcal infections but they are thought to be found in hospitalized patients predominantly. We know that with a more thorough, extensive culture, however, Enterococci and other urinary pathogens can be isolated from many patients out in the community. Enterococci and other Strep/Staph species, plus Klebsiella and Pseudomonas can be found via a broth culture. I have posted about these findings before and continue to hope more labs will begin to look more extensively for bacteria that could be causing symptoms. E. coli are not the only UTI pathogens but are more easily found by the typical agar plate culture grown for 48 hours. Some bacteria are slower growing and may take 5 days or more to appear. Shelley has been doing her own culturing and hopefully will continue to report what she is finding.

I also read in a brief letter to the editor in the New England Journal of Medicine that researchers at Duke Univ have found biofilms are formed by one species of bacteria found in Bacterial Vaginosis. This infection has been difficult for many to treat. Biofilms can account for the tenacity of infections and the difficulty in reaching them through antibiotic use. It is good news that they are working on new treatments.

Those of us who have treated our chronic UT symptoms with antibiotics, due to a finding of bacteria using the broth culture, have found that it takes long term treatment. The presence of biofilms may explain the time frame so the publicizing of biofilm formation is helpful.

Martha F

[purpleviolet]

I subscribe to the ICA newsletter and this one is a doozy. The thing that bums me out is that the docs don't keep up to the info. PV

[glenda]

Here is the link to His article:

http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=257145&ref=25

[Katrina]

Thank you ISONormal!!

[glenda]

Yes, ISONormal, Thank you!!!

[purpleviolet]

Great link - note he says that there may be bacteria in the wall that doesn't show up in a typical urine culture. Doesn't that fly in the face of the research that didn't find any bacterial DNA in IC bladders. I'm sure some of us, but not all must be harboring something. Maybe that's why I feel better after Cipro for a week, even though doc said no infection was found.PV

[Romans8:28]

Thanks guys, I've been lost in this research article and collecting articles for a notebook on biofilms I am researching for my doctor. Just popped in here, cause I've missed you guys and bingo just the article I need!
I love this place!:) :grouphug:

[ISONormal]

Terrific. Great to hear.

(Love that verse. It has had great meaning for me personally.)

[Oxana]

It has had great meaning for me too. Thanks!

[Martha13]

PV,

We did a study (unpublished) that showed a lot of bacteria in the urine specimens of IC patients and the controls via broth culturing which is much more sensitive than the traditional lab culturing. So as I have said before there are "triggers" that cause symptoms for some, not all of us. Also, we now know that many species of bacteria can be in biofilms and so hard to culture.

Some have looked for bacteria in the wall (biopsies) of the bladder via PCR. My understanding is that specific primers (chemicals) must be used to find specific bacteria. This is not always explained by the researchers who announce their findings. For instance we were looking for Enterococci which we knew are common in IC specimens and not commonly found by traditional cultures. The researcher told me she would have to design specific primers to find it and she did in many of the urine specimens she was testing. The same would be true if they looked at biopsies - the primers have to be specific or they won't find it.

In other words, bacteria are there but the testing/culturing is the key. The mainstream says that bacteria are not involved in chronic UT patients because the labs do not report finding any growth in these patients. But there probably is bacteria there, they just don't use sensitive enough culturing to find it or it is hiding in biofilms and escapes detection.

Dr. Hultgren concentrates on E.coli because that is most easily found by the usual culturing, but my belief is that when more sophisticated culturing techniques are used on patients there will be many more species found. Even the agar plate culture, if allowed to grow long enough, can find other species.

Slowly, but surely, they are arriving at better testing and understanding the UTI bacteria that are there.

Martha

[Michelle B]

PV,

We did a study (unpublished) that showed a lot of bacteria in the urine specimens of IC patients and the controls via broth culturing which is much more sensitive than the traditional lab culturing.

Martha
Is this the uncompleted, self-funded study referenced elsewhere on this site? Was there any kind of objective peer review of your findings? Are you a medical professional? I'm not questioning what you found, but would like some background information with which to better understand your statements.

[MarthaF]

Michelle,

You have asked some good questions! I am a patient who years ago was treated successfully after a broth culture (by Dr. Fugazzotto, retired microbiologist). He recommended antibiotics that the bacteria he found would be sensitive to. Many others used his culturing and were treated successfully with antibiotics. No study on his method was ever done that was overseen by a medical entity or published, however.

A few years ago I discovered that a friend, a molecular neurobiologist and researcher at a university, would be willing to help do a study and use the PCR (polymerase chain reaction), testing on patient specimens. I funded the study and we first tested both patients and controls with a broth culture and then planned to test all of these with the PCR. We ran out of money before the PCR testing was complete, however. A microbiologist in Canada is hoping to complete the study but there have been logistical problems in sending the DNA which is what is used.

But the broth culture isolated many species of bacteria in both the patient and control specimens. The portion of the PCR testing that was completed found more postitives in the patients than in the controls however. It is not unusual in infectious diseases to discover that asymptomatic people can carry bacteria without manifesting symptoms. H.pylori is found in a large percentage of the population but only some of these develop an ulcer. No one knows why. I think that is true of those who have bacteria in their bladders - something triggers an infection and so far no one has explained it. It may be trauma of some kind combined with genetic factors.

But an important key is the culturing. Right now labs do not allow cultures to grow very long and some species take more time and more sensitive techniques to appear. My cultures were always negative until I had a broth culture. But broth culturing (a method used long ago) fell out of favor and the agar plate has been the gold standard. Labs and doctors seem satisfied with it. But recently I learned that UCLA has developed a very high tech method of identifying UTI bacteria. I wrote to them and they said it is not ready to be used clinically yet but when it is it will identify pathogens in 40 minutes:
http://jcm.asm.org/cgi/content/abstract/44/2/561
This will probably be the wave of the future in UTI testing. The agar plate has been in use for over 50 years so it is time.

We also now know that bacteria form biofilms and that helps explain why we have recurrent infections and why it takes so long to treat bacteria. The antibiotics cannot penetrate the biofilms easily so there is a need for better treatment methods.

I do not have any scientific training but have been motivated to try to learn as much as I can about UTIs and try to keep up with the latest developments. The mainstream does not believe in a bacterial factor in what is diagnosed as IC, but they do not know what causes it and have not completely ruled out infection. They just have not found pathogens using the testing they do. On the other hand many of us know we have bacteria due to having had more sensitive cultures. It does not really matter what we call it as long as we find a way to treat the cause. More and more diseases are being found to have a bacterial cause today and bacteria are usually treatable.

I hope this explains my comments previously about bacteria. I wish more research were devoted to a bacterial component in IC. The researcher submitted a grant proposal to the NIH to study this aspect based on her preliminary findings but it was turned down. It is very hard to win NIH grants these days and as she said she was "the new kid on the block". Perhaps when better testing becomes common more bacteria will be found than is today. If you read the UCLA abstract you will see they mention at least 5 UTI pathogens and there many more not quite so common. Streptococci and Staph are common according to the broth culture results and these can take more than a week or ten days to treat.

I would welcome any comments anyone has about their experience with bacterial infections and how they were identified. I don't have any credentials to be considered an expert, but all of us are forced to learn more than we ever wanted to know about UT problems unfortunately!

Martha F

[Oxana]

90% of all illness are causing by bacteria. Some of them very hard to find, but in the near future we will see good progress about it.

NOTE: THIS IS NOT A PROVEN FACT

[ihurttoo]

Just want to let ya'll know, that I am very interested in your discussions. I havent been posting, just because I am not even smart enought to know what questions to ask, when it pertains to this. However, I am very interested in all of this. Thank you to the people who post the questions and to those that answer them, as well as thank you to those who post these studies. Keep up the good work, guys! Hugs, Amy

[Oxana]

Many people affraid of antibiotical treatment especially for long time. Yes, it can be hurmful, but anti-yeast medicine and probiotics can help protect us. Anyway, I think that we really don't know how hurmful Elmiron and another drugs using in IC treatment can be too ;) .

[PlainJane]

Has anyone else been treated for Klebsiella? How long did the treatment take?

Thanks!

~PlainJane

[mela414]

Boy, I just got a round to reading this thread. I guess I needed to go through another UTI to get me on board. Very interesting. I look forward to reading the articles in the above links.

[Dixiefireball]

I suffer monthly with real UTI's this has been going on for a little over two years now. You can imaging how much pain and suffering I'm in. I also have hunner's that grows on the inside and outside of the bladder lining. Due to all these UTI's and hunners My bladder is so thin the Uro can see my bowels threw my bladder lining now.
I find this very informational. Thank you so much for posting this. I'm going to print it out to take it to my uro. He is a great uro he is kind caring, understanding and tries to stay up to date with all new research he also does research himself and has money tied up in this.
He also has spoken with other uro's that sp. In infection dis. Even those sp. don't have no clue in what to try with me to help. What they advice we have already tried with some type of failer.:( Thank you so much again for posting this!!
Rhonda

[louise]

Hi, I can't locate on these posts just when this article on recurring uti's was published in the ICA Newsletter. Can you please tell me which month or months this article was in? I subscribe to the Newsletter and may have some older ones in which the article was printed. Thank you very much for your help.

Louise

[dbritts]

Hi,
I've never posted to the boards, but I have been dealing with an enterococcus infection for the last 3 yrs. I don't know if this information will be helpful to anyone, but my dr. finally started sending my urine cultures to our local hospital for what is called a "resin culture"--I think this must be similar to a broth culture. This is when my urologist discovered I had e. faecalis and MRSE. It was a good news, bad news situation because I've taken endless rounds of antibiotics, been sent to 3 infectious disease drs. and the only time I don't have an infection is when I'm on Cipro because it has the most sensitivity for my bacteria. I also have major yeast problems. I've read alot about sending your urine away, but you might check with your dr. and see if he will order a resin culture. My insurance covers them so they cost about 8 dollars and since I have to have them frequently it has been a lifesaver. At least I finally know I have UTIs--if they could just figure out how to get rid of them!! Good luck to everyone dealing with UTIs on top of IC. This is a great board with alot of supportive people and good info.

[MarthaF]

I would be very interested to know more about a resin culture since I haven't heard of that type. If it is more extensive than the broth culture then it is worth a try.

Have you ever been given Amoxicillin for the Enterococcus? That is pretty effective and not too hard to tolerate. Also, what is MRSE? I have heard of MRSA which is Multiple Resistant Staph Aureus, I believe. those of us who have used antibiotic therapy for Enterococcus have found that we have to take it for 6 to 12 months steadily - not stopping and starting - to give the bladder a chance to heal. The bacteria may be in a biofilm or in the tissues and so hard to detect and hard to treat. Email me if you would like any more information. Your situation is not unusual and many have treated successfully with antibiotics but there are some fine points to the treatment.

If people do not get well they find they have have other infections that are not found by traditional UTI culturing. In other words other infections can cause bladder symptoms - infections with Chlamydia, Mycoplasma, Lyme, among others and testing for these is challenging.

Martha

[mom_in_ma]

Actually, I'm just as interested in the HPV connection! I tested positive for HPV about 10 years before I developed pre-cancerous cervical cells. The virus goes dormant for quite some time. Anyway, I developed IC about a year after surgery for the cervical stuff. I was stunned when I read the research study (in one of the first posts on this thread) that showed HPV in the bladder and that it has been tied to hemorraghic (sp?) cystitis. My husband and I have wondered about the HPV connection for some time and it makes so much sense.

That said, I'm wondering if anti-virals might help with some cases of IC. Just a thought.

---
Could Viruses Play a Role in IC?
Fioriti D, Penta M, Mischitelli M, Degener AM, Pierangeli A, Gentile V, Nicosia R, Gallinelli C, Chiarini F, Pietropaolo V. Interstitial cystitis and infectious agents. Int J Immunopathol Pharmacol. 2005 Oct-Dec;18(4):799-804.

These Italian researchers looked for evidence of various bacteria and viruses in a biopsy specimen from an IC patient. They found the genetic material of human polyoma virus BK (BKV) and human papilloma virus 66 (HPV-66). The researchers did not find evidence of herpes virus type 1 and 2, adenovirus, or of two types of bacteria, Chlamydia trachomatis and Mycoplasma genitalium. The researchers speculated that co-infection with a virus might play a role in IC. (BKV is very commonly found in human serum and is known to stay dormant in the urinary tract. It has been linked to hemorrhagic cystitis and nephritis. HPV-66 is one of the types of human papilloma virus that may cause cervical cancer.)

[mich2604]

momin ma- my hollistic dr printed me that article a few weeks ago. he tested me for the bkv(thru blood) but as you know HPV has to be cultured/biopsied.

Have you tried any antivirals? I was on valtrex and it did seem to help me overall, but i wasnt on it long enough to see if it helped the bladder.

[dbritts]

Martha,

I've never had a broth culture so I don't know if they pick up more than a resin culture. Resin is just a different medium to culture your urine, but it takes about a week and it picks up bacteria like enterococcus, staph, klebsiella--things you don't find on the standard culture. Your report shows what bacteria you have, the colony count, which antibiotics will work and which ones the bacteria is resistant to--it then breaks down the degree of sensitivity of your bacteria to the antibiotics that work, so your dr. can make the best treatment choice. Because of the enterococcus, this is the only culture my uro uses now. It's great because several times the bacteria has become resistant to the antibiotic and then he can change treatment. My dr. always assumed because I had IC that I couldn't have a UTI even though he started seeing bacteria under the microscope. The standard culture always came back negative, so he decided to go further. He's not comfortable with long-term antibiotics, so the infection always comes back. He's agreed to 3 straight months, but from reading this board, I don't think that will probably be enough. MRSE is methillin-resistant staph epidermidis and I haven't had it in my urine in awhile. I have used amoxicillin several times, but right my bacteria is most sensitive to Cipro. After reading this board, it seems like enterococcus is a big problem for some IC patients.

[jen74]

I also found the broth culture info interesting as well. But every doctor I ask about it, they say it is a bunch of nonsense. They say that everyone will have some amount of bacteria in their urine, especially if it is left to grow for days, and that this bacteria is harmless and not a cause of IC. I dont know what to think. I have heard of some women getting better after being on long term antibiotics, but also I would be very leary of that too since antibiotics can really mess you up if taken to much. For instance, my stomach motility issues started after I took 2 courses of antibiotics a few years ago for a nasty throat infection and I have never been the same since. They can mess you up bad. I have a friend who got severe gastroparesis from being on them long term and now she has a permanant feeding tube because her digestive tract does not work anymore.
It is a hard decision to make I guess. But I just dont know why the doctors are not looking more deeply into this if bacteria is a possible cause of IC.
Jen

[mom_in_ma]

mich,
I've not tried anti-virals...but I'm game to try them. I'd have to do more research on them anyway before presenting the idea to my doctors. I'm of the opinion that there are many different types of IC, but it just makes so much sense to me that the hpv could wreck havok on my bladder just as it did with cervix. the tissues are the same.

[dbritts]

I don't know what to think either. I have GI issues too--was diagnosed with Crohns, then rediagnosed with post-infectious IBS and a motility disorder. My GI dr. says to stop the antibiotics because of the stomach problems. I don't think my IC was caused by bacteria because I've had it for 17 yrs. and this stuff started 3 yrs. ago. My urologist only uses antibiotics if I'm running a temp, sees blood in my urine and that happens about 2 weeks after I finish a course of antibiotics. I think this infection is a separate issue, but maybe having IC makes it harder to get rid of something like this. I did notice in one of the Guest Lectures that one of the drs. mentioned that he sees chronic UTIs in his patients with some type of immune defiency. I've asked my dr. if we could explore that route. It is a hard decison to know what the right thing to do is. I'm sorry to read about your friend.