The Urinary Tract Microbiome
At some point in your life, you have probably heard about the gut microbiome; the magic community of bacteria that affect everything from your brain to your poop. But, did you know that there are 17 other microbiomes in your body?! 🤯
Turns out, pretty much every organ system has a microbiome! The bacteria in these microbiomes work together to protect you. Sometimes though, the bacteria can go wild and harm you. So why does this matter?
Antimicrobial resistance and increased bacterial infections make it important that we learn how these microbiomes work to create improved treatments. As the leading cause of bacterial infections in adults, the urinary tract microbiome is at the top of the list.
Introduction to the Problem
So, you are probably wondering why the urinary tract microbiome is so important. It’s not because it is the biggest, or has the most bacteria, but instead because it is a leading contributor to antimicrobial resistance.
Urinary tract infections are a leading cause of overprescribed antibiotics. 50% of women have a UTI (urinary tract infection) at some point in their lives, often leading to reoccurring infections. Right now, UTIs are mainly treated with antibiotics. This means with every infection, you have a higher chance of antimicrobial resistance.
UTIs are the leading bacterial infection in adults across the world, costing over $3.5 billion in healthcare every year. They are expensive, damaging, and risky. So now all we need to do is find a solution. Easy, right?
Urinary Tract Microbiome and Its Role in the Solution
Up until recently, we thought that the urinary tract should be completely sterile. This meant taking high doses of antibiotics to attempt to kill all living things in the urinary tract.
Eventually, we realized that this method wasn’t making people better, but instead, they were getting worse. That’s when the urinary tract microbiome was first discovered.
Healthy bacteria need to grow in the urinary tract to keep the host healthy. By keeping it sterile we were preventing this symbiotic relationship from happening.
Now we know that high concentrations of Lactobacillus, accompanied by low concentrations of diverse bacteria actually means a healthy urinary tract system.
So, how could this knowledge actually help us prevent UTIs in a way that doesn’t put the host at risk? By understanding the microbiota that lives in the urinary tract, we can create therapeutics that target pathogens while promoting healthy bacteria.
On top of that, by promoting bacteria that protect us from pathogens we can reduce the risk of infection in the first place.
Right now, we don’t know a ton about the urinary tract microbiome, because it is a more recent discovery. Fortunately, we know enough to have a potential plan for protection from UTIs.
Lactobacillus
How could a bacteria protect you from UTIs, HIV, STDs, and even bacterial vaginosis? A study done by Thomas-White et al. found that healthy urinary tracts have high concentrations of lactobacillus, which is also an important bacteria in the vaginal microbiome.
When this occurrence of lactobacillus was studied further in 2019, it was found that the bacteria could prevent the occurrence of Chlamydia, as well as other, sexually transmitted diseases and uropathogens (the bacteria that causes UTIs).
Ok, so in healthy urinary tract microbiomes there are large amounts of Lactobacillus, but what about unhealthy microbiomes? How can we increase Lactobacillus?
As I mentioned before, an unhealthy urinary microbiome has a more diverse range of bacteria. This means a lower concentration of Lactobacillus and higher concentrations of unwanted bacteria, such as E.coli.
This diversity results in something called dysbiosis, which means that the microbiome is not in balance. Dysbiosis can lead to a multitude of issues, such as UTIs.
Fortunately, we have found a potential way to correct dysbiosis in the urinary tract. In 2011, a study demonstrated that taking a Lactobacillus probiotic could help regulate the urinary tract and vaginal microbiome, leading to a moderate reduction in UTIs.
Despite this, even the supplement didn’t completely prevent UTIs and was more beneficial to the vaginal microbiome. Basically, there is still lots of room for research and improvement in understanding the urinary tract microbiome and creating treatments for UTIs. So what comes next?
Potential Areas for Further Research
Recently, the University of Texas published a study overviewing new advances in the field of the Urinary Tract microbiome and the potential it holds for the future. Here is a list of the potential studies and areas they overviewed:
- Lactobacillus role in protection against colonization of uropathogens
- Study of microbial and genomic ecology of UT microbiome in consistent heath and disease
- Modeling community dynamics of UT-resident microbial populations during infection
- Deeper sequencing of metagenomics
- Calculation of absolute abundances may help ascertain the fate of putative commensal populations during a UTI.
- Temporal stability to understand the microbial niche and incorporate measurements of dysbiosis.
- Longitudinal cohorts with participants providing urine over a defined time course to establish baseline temporal variation in UT microbiome.
- Shed light on the contribution of periodic changes, such as UTI and menstruation.
- Functional analysis by WGMS
- Clear association with host phenotype
- Unknown temporal dynamics
- High variability
- Change before, during, and after infection
- Affect of antibiotics on UT microbiome
- Disruptions in other microbiota can cause cancer, bacterial vaginosis, inflammatory bowel disease, etc.
- Identify core gene sets and metabolic pathways needed for microbial communities to function in UT
- Use of uroplakins by UT microbiota for adhesion sites
- Interactions between compositional dynamics of microbiome and incidence of UTIs, as well as general microbe interactions
- Lactobacillus, Corynebacterium, Streptococcus, Actinomyces, and Staphylococcus
- Male vs Female
- Enrichment of microbes during UTI
- Interaction between vaginal and UT microbiome
- Both are dominated by Lactobacillus
- Protection vs Harm
- 2017 Gilbert report- exposures to Gardnerella vaginitis can awaken UPEC reservoirs
- Abundance of antimicrobial resistance genes in microbial communities
- Hasman H- rapid whole-genome sequencing for detection and characterization of microorganisms directly from clinical samples
- WGMS study to show how current antibiotic therapy has limits
- 2019 Mulder et al. assess the effect of antibiotic therapy on UT microbiome composition in elderly
· Depleted Lactobacillus
- WGMS study to show metagenomic signatures of UTI and ASB
- Viral component of the urinary microbiome
- Moustafa et al. found mammalian viruses and bacteriophages while identifying microbial signatures.
- Longitudinally designed WGMS studies to understand microbial ecology and pathobiology of rUTIs
- Understanding polymicrobial UTIS
- Synergistic interaction between P. mirabilis and Staphylococcus saprophyticus in increasing incidence of ascending pyelonephritis.
- Synergistic interaction of P. mirabilis and UPEC in coinfection through metabolic interactions that enhance colonization.
- 2016 Keogh et al. synergistic relationship between E. faecalis and UPEC in stimulating biosynthesis of iron uptake by UPEc
- Synergistic relationships within the UT microbiome for targeted UTI therapies
- Potential of probiotics as a novel UTI therapeutic
- Using lactobacillus
- Understanding how urinary microbiota directly influences host health.
- Vaginal microbiome transplantation
If you want to learn more about the urinary tract microbiome here is the University of Texas study. The Urinary Tract microbiome is an exciting, new field with lots of potentials to help people!
If you’ve made it this far, thank you! I am a 15-year-old who is interested in regenerative medicine, biocomputing, and public health. If you want to see me continue to grow and 10X myself, sign up for my newsletter here!
