Health
Nerve overgrowth identified as cause of pain in recurrent urinary tract infections
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A perplexing problem for people with recurrent urinary tract infections (UTIs) is persistent pain even after antibiotics have successfully eliminated the bacteria.
Now, Duke Health researchers have identified a likely cause: an overgrowth of nerve cells in the bladder.
The discovery was published March 1 in the journal scientific immunology, This offers a potential new approach to managing recurrent UTI symptoms that more effectively targets the problem and reduces unnecessary antibiotic use.
“Urinary tract infections account for nearly 25% of infections in women,” said lead author Soman, professor of pathology, molecular genetics and microbiology, integrative immunobiology, and cell biology at Duke University School of Medicine.・Dr. Abraham said. .
“Most cases are recurrent urinary tract infections, and patients often complain of chronic pelvic pain and frequent urination even after multiple courses of antibiotics,” Abraham said. “Our study uncovers the underlying cause for the first time and identifies potential new treatment strategies.”
Abraham et al. took bladder biopsies from patients with recurrent urinary tract infections who were experiencing pain despite the absence of culturable bacteria in their urine. Using biopsies from people without UTIs as a comparison, they found evidence that sensory nerves are highly activated in UTI patients, which could explain their persistent pain and frequent urination.
Further research in mice revealed a unique condition within the bladder, an underlying phenomenon that prompts activated nerves in the lining to bloom and grow with each infection.
“Typically, each time a urinary tract infection develops, bacteria-laden epithelial cells slough off, causing significant destruction of nearby neural tissue,” said Dr. said Byron Hayes, a former postdoctoral fellow in the Department of Science. “These events trigger a rapid repair program of the damaged bladder, involving extensive regrowth of destroyed nerve cells.”
This immune response, which includes repair activities, is led by mast cells, which are immune cells that fight infections and allergens. Mast cells release chemicals called nerve growth factors, which promote hyperproliferation and increase nerve sensitivity. The result is pain and a sense of urgency.
Researchers were able to address these symptoms by giving research mice a molecule that suppresses the production of nerve growth factor, which is produced by mast cells.
“This research helps shed light on a puzzling clinical condition that increases healthcare costs and impacts the quality of life of millions of people, primarily women. “Understanding the crosstalk between nerves is an important step toward effective treatment for people who suffer from relapse,” Abraham said. Urinary-tract infection. ”
Dr. Soman Abraham, Lead Author
In addition to Abraham and Hayes, study authors include Hae Eun Choi, Abhay P.S. Rasool; Chunjing Bao, Jianling Shi, Yul Huh, Michael W Kim, Andrea Mencarelli, Pradeep Bist, Lai Guan Ng, Changming Shi, Joo Hwan Nho, Aram Kim, hana Yoon, Donghun Lim, Johanna L Hannan, J Todd Purves, Francis M Hughes Jr. and Lu Long Jie.
This study was supported by funding from the National Institutes of Health (K12-DK100024, R01-DK121969, R01-DK121032, R01-GM144606), the National Research Foundation of Korea (2020R1C1C1003257), and Korea University Grant.
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