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Lederer AK, Michel MC. Natural Products in the Treatment of Lower Urinary Tract Dysfunction and Infection. Handb Exp Pharmacol 2024. [PMID: 38411727 DOI: 10.1007/164_2024_708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The popularity of natural products for the treatment of lower urinary tract symptoms (LUTS) differs considerably between countries. Here we discuss the clinical evidence for efficacy in two indications, male LUTS suggestive of benign prostatic hyperplasia and urinary tract infections, and the mechanistic evidence from experimental studies. Most evidence for male LUTS is based on extracts from saw palmetto berries, stinging nettle roots, and pumpkin seeds, whereas most evidence for urinary tract infection is available for European golden rod and combined preparations although this field appears more fragmented with regard to extract sources. Based on differences in sample collection and extraction, extracts from the same plants are likely to exhibit at least quantitative differences in potential active ingredients, which makes extrapolation of findings with one extract to those of others potentially difficult. While only limited information is available for most individual extracts, some extracts have been compared to placebo and/or active controls in adequately powered trials.
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Affiliation(s)
- Ann-Kathrin Lederer
- Department of General, Visceral and Transplant Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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Das S. Natural therapeutics for urinary tract infections-a review. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2020; 6:64. [PMID: 33215041 PMCID: PMC7498302 DOI: 10.1186/s43094-020-00086-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background The recurrence of the urinary tract infections (UTI), following the antibiotic treatments suggests the pathogen’s resistance to conventional antibiotics. This calls for the exploration of an alternative therapy. Main body The anti-uropathogenic and bactericidal activity of many plant extracts was reported by many researchers, which involves only preliminary antibacterial studies using different basic techniques like disk diffusion, agar well diffusion, or minimum inhibitory concentration (MIC) of the crude plant extracts, but reports on the specific action of the phytoconstituents against uropathogens are limited. Vaccinium macrocarpon Aiton (cranberry) is the best-studied home remedy for UTI. Some evidences suggest that proanthocyanins present in cranberry, prevent bacteria from adhering to the walls of the urinary tract, subsequently blocking the further steps of uropathogenesis. Probiotics such as Lactobacillus and Bifidobacterium are beneficial microorganisms that may act by the competitive exclusion principle to defend against infections in the urogenital tracts. Reports on potential vaccine agents and antibodies targeting the different toxins and effecter proteins are still obscure except uropathogenic E. coli. Conclusion This review highlights some of the medicinal herbs used by aborigines to prevent or treat acute or chronic urinary tract infections, botanicals with established urobactericidal activity, clinical trials undertaken to compare the efficacy of cranberry products in UTI prevention, and other natural therapeutics reported for UTI.
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Affiliation(s)
- Sarita Das
- Department of Botany, Berhampur University, Bhanja Bihar, Berhampur, Orissa 760007 India
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Chen YC, Chang CC, Chiu THT, Lin MN, Lin CL. The risk of urinary tract infection in vegetarians and non-vegetarians: a prospective study. Sci Rep 2020; 10:906. [PMID: 32001729 PMCID: PMC6992707 DOI: 10.1038/s41598-020-58006-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
Urinary tract infection (UTI) is caused principally by ascending Escherichia coli infection via an intestine-stool-urethra route. Recent studies found that the strains of E. coli causing UTIs, called extra-intestinal pathogenic E. coli (ExPEC), were distinct from the intestinal pathogenic strains and normal commensal strains. Further analysis found the meat including poultry and pork is the major reservoir for ExPECs. Vegetarians avoid meat and should theoretically have less exposure to ExPEC. However, no study thus far has examined whether vegetarian diets reduce the risk of UTI. Our aim was to examine the association between vegetarian diet and UTI risk in a Taiwanese Buddhist population. We prospectively followed 9724 Buddhists free of UTI from 2005 to 2014. During the 10-year follow-up, 661 incident UTI cases were confirmed. Diet was assessed through a food frequency questionnaire. Cox regression was used to evaluate the prospective association between a vegetarian diet on risk of UTI while adjusting for age, sex, educational level, alcohol-drinking, smoking, hypertension, diabetes mellitus, hyperlipidemia, and disease conditions predisposing to UTIs. Overall, vegetarian diet was associated with 16% lower hazards (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.71-0.99). In subgroup analysis, the protective association between vegetarian diet and UTI is observed mainly in the female (HR: 0.82, 95% CI: 0.69-0.99), never smokers (HR: 0.80, 95% CI: 0.67-0.95), and for uncomplicated UTI (HR: 0.81, 95% CI: 0.68-0.98).
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Affiliation(s)
- Yen-Chang Chen
- Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Chen Chang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tina H T Chiu
- Department of Nutritional Science, Fu-Jen Catholic University, Taipei, Taiwan
| | - Ming-Nan Lin
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
- Department of Family Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chin-Lon Lin
- Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan.
- Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
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Singh I, Gautam LK, Kaur IR. Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: a randomized placebo-controlled clinical research study. Int Urol Nephrol 2016; 48:1379-86. [PMID: 27314247 DOI: 10.1007/s11255-016-1342-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of cranberry extract (PAC-A ~ proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli) and its efficacy/tolerability in patients with subclinical or uncomplicated recurrent UTI (r-UTI). MATERIALS AND METHODS After obtaining clearance from the ethics committee and administering a written informed consent, 72 patients with r-UTI were enrolled as per protocol (November 2011 to March 2013) in this prospective study, to randomly receive (PAC-A: group I, 36) or (placebo: group II, 36), for 12 weeks. Any change/reduction in the incidence of r-UTI at 12 weeks was construed to be the primary endpoint of this study. RESULTS After 12 weeks, bacterial adhesion scoring decreased (0.28)/(2.14) in group I/II (p < 0.001); 32/36 (88.8 %) and 2/36 (5.5 %) in groups I and II, respectively, turned MRHA negative (p < 0.001); biofilm (p < 0.01) and bacterial growth (p < 0.001) decreased in group I; microscopic pyuria score was 0.36/2.0 in group I/II (p < 0.001); r-UTI decreased to 33.33 versus 88.89 % in group I/II (p < 0.001); mean subjective dysuria score was 0.19 versus 1.47 in group I/II (p < 0.001), while mean urine pH was 5.88 versus 6.30 in group I/II (p < 0.001). No in vitro antibacterial activity of cranberry could be demonstrated, and no adverse events were noted. CONCLUSIONS The overall efficacy and tolerability of standardized cranberry extract containing (PAC-A) as a food supplement were superior to placebo in terms of reduced bacterial adhesion; bacterial MRHA negativity; urine pH reduction; and in preventing r-UTI (dysuria, bacteriuria and pyuria). Larger randomized controlled trials are needed to elucidate the precise role, exact dose and optimal duration of PAC-A therapy in patients at risk of r-UTI.
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Affiliation(s)
- Iqbal Singh
- Departments of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Shahdara, Dilshad Garden, New Delhi, 110095, Delhi, India.
| | - Lokesh Kumar Gautam
- Departments of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Shahdara, Dilshad Garden, New Delhi, 110095, Delhi, India
| | - Iqbal R Kaur
- Departments of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, New Delhi, 95, India
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Smeriglio A, Tomaino A, Trombetta D. Herbal products in pregnancy: experimental studies and clinical reports. Phytother Res 2014; 28:1107-16. [PMID: 24399745 DOI: 10.1002/ptr.5106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023]
Abstract
The aim of this work is to provide an update from an overview of the literature of the most frequently consumed herbal remedies during pregnancy, both alone and concomitantly with prescribed medications and particularly on their side effects to the mother and fetus. We have also analyzed some of the adverse interactions that may occur due to concomitant use of herbal and pharmaceutical products during pregnancy. Herbal remedies are not evaluated according to the same standards as pharmaceuticals, and in the USA some of it are not licensed but sold as food supplements. There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines used in pregnancy and lactation. If 'traditional use' is the only available information, the pregnant woman should be made aware of this to enable her to make an informed decision concerning potential use.
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Affiliation(s)
- Antonella Smeriglio
- Università degli studi di Messina, Department of Pharmaceutical Sciences and Health Products, Viale Annunziata, 98168, Messina, Italy
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Rane HS, Bernardo SM, Howell AB, Lee SA. Cranberry-derived proanthocyanidins prevent formation of Candida albicans biofilms in artificial urine through biofilm- and adherence-specific mechanisms. J Antimicrob Chemother 2013; 69:428-36. [PMID: 24114570 DOI: 10.1093/jac/dkt398] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Candida albicans is a common cause of nosocomial urinary tract infections (UTIs) and is responsible for increased morbidity and healthcare costs. Moreover, the US Centers for Medicare & Medicaid Services no longer reimburse for hospital-acquired catheter-associated UTIs. Thus, development of specific approaches for the prevention of Candida urinary infections is needed. Cranberry juice-derived proanthocyanidins (PACs) have efficacy in the prevention of bacterial UTIs, partially due to anti-adherence properties, but there are limited data on their use for the prevention and/or treatment of Candida UTIs. Therefore, we sought to systematically assess the in vitro effect of cranberry-derived PACs on C. albicans biofilm formation in artificial urine. METHODS C. albicans biofilms in artificial urine were coincubated with cranberry PACs at serially increasing concentrations and biofilm metabolic activity was assessed using the XTT assay in static microplate and silicone disc models. RESULTS Cranberry PAC concentrations of ≥16 mg/L significantly reduced biofilm formation in all C. albicans strains tested, with a paradoxical effect observed at high concentrations in two clinical isolates. Further, cranberry PACs were additive in combination with traditional antifungals. Cranberry PACs reduced C. albicans adherence to both polystyrene and silicone. Supplementation of the medium with iron reduced the efficacy of cranberry PACs against biofilms. CONCLUSIONS These findings indicate that cranberry PACs have excellent in vitro activity against C. albicans biofilm formation in artificial urine. We present preliminary evidence that cranberry PAC activity against C. albicans biofilm formation is due to anti-adherence properties and/or iron chelation.
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Affiliation(s)
- Hallie S Rane
- Section of Infectious Diseases, New Mexico Veterans Healthcare System, Albuquerque, NM, USA
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Davidson E, Zimmermann BF, Jungfer E, Chrubasik-Hausmann S. Prevention of Urinary Tract Infections withVacciniumProducts. Phytother Res 2013; 28:465-70. [DOI: 10.1002/ptr.5047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/02/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Elyad Davidson
- Pain Relief Unit, Department of Anesthesia; Hadassah Hebrew University Hospital; Jerusalem Israel
| | - Benno F. Zimmermann
- Department of Nutrition and Food Sciences - Food Chemistry; University of Bonn; Endenicher Allee 11-13 53115 Bonn Germany
- Institut Prof. Dr. Kurz GmbH; Eupener Strasse 161 50933 Köln Germany
| | - Elvira Jungfer
- Department of Nutrition and Food Sciences - Food Chemistry; University of Bonn; Endenicher Allee 11-13 53115 Bonn Germany
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Grace MH, Guzman I, Roopchand DE, Moskal K, Cheng DM, Pogrebnyak N, Raskin I, Howell A, Lila MA. Stable binding of alternative protein-enriched food matrices with concentrated cranberry bioflavonoids for functional food applications. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2013; 61:6856-64. [PMID: 23786629 PMCID: PMC3769697 DOI: 10.1021/jf401627m] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Defatted soy flour (DSF), soy protein isolate (SPI), hemp protein isolate (HPI), medium-roast peanut flour (MPF), and pea protein isolate (PPI) stably bind and concentrate cranberry (CB) polyphenols, creating protein/polyphenol-enriched matrices. Proanthocyanidins (PAC) in the enriched matrices ranged from 20.75 mg/g (CB-HPI) to 10.68 mg/g (CB-SPI). Anthocyanins (ANC) ranged from 3.19 mg/g (CB-DSF) to 1.68 mg/g (CB-SPI), whereas total phenolics (TP) ranged from 37.61 mg/g (CB-HPI) to 21.29 mg/g (CB-SPI). LC-MS indicated that the enriched matrices contained all identifiable ANC, PAC, and flavonols present in CB juice. Complexation with SPI stabilized and preserved the integrity of the CB polyphenolic components for at least 15 weeks at 37 °C. PAC isolated from enriched matrices demonstrated comparable antiadhesion bioactivity to PAC isolated directly from CB juice (MIC 0.4-0.16 mg/mL), indicating their potential utility for maintenance of urinary tract health. Approximately 1.0 g of polyphenol-enriched matrix delivered the same amount of PAC available in 1 cup (300 mL) of commercial CB juice cocktail, which has been shown clinically to be the prophylactic dose for reducing recurring urinary tract infections. CB-SPI inhibited Gram-positive and Gram-negative bacterial growth. Nutritional and sensory analyses indicated that the targeted CB-matrix combinations have high potential for incorporation in functional food formulations.
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Affiliation(s)
- Mary H. Grace
- Plants for Human Health Institute, Food, Bioprocessing, and Nutrition Sciences Department, North Carolina State University, North Carolina Research Campus, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
| | - Ivette Guzman
- Plants for Human Health Institute, Food, Bioprocessing, and Nutrition Sciences Department, North Carolina State University, North Carolina Research Campus, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
| | - Diana E. Roopchand
- Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences, Foran Hall, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Kristin Moskal
- Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences, Foran Hall, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Diana M. Cheng
- Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences, Foran Hall, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Natasha Pogrebnyak
- Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences, Foran Hall, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Ilya Raskin
- Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences, Foran Hall, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Amy Howell
- Marucci Center for Blueberry and Cranberry Research, Rutgers University, 125A Lake Oswego Rd, Chatsworth, NJ 08019, USA
| | - Mary Ann Lila
- Plants for Human Health Institute, Food, Bioprocessing, and Nutrition Sciences Department, North Carolina State University, North Carolina Research Campus, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
- Corresponding Author: Phone (704) 250-5407; Fax: (704) 250-5409.
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Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo) 2012; 67:661-8. [PMID: 22760907 PMCID: PMC3370320 DOI: 10.6061/clinics/2012(06)18] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/13/2012] [Indexed: 11/18/2022] Open
Abstract
Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.
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Affiliation(s)
- Marcelo Hisano
- Laboratory of Medical Investigation, Department of Urology (LIM55), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Biofilm formation and virulence of uropathogenic Escherichia coli in urine after consumption of cranberry-lingonberry juice. Eur J Clin Microbiol Infect Dis 2011; 31:655-62. [PMID: 21822564 DOI: 10.1007/s10096-011-1355-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
Cranberry-lingonberry juice (CLJ) was effective in preventing urinary tract infections (UTIs) in our earlier randomized clinical trial. We aimed to test whether consumption of CLJ at a similar dose to earlier reduces the biofilm formation and virulence of uropathogenic Escherichia coli in urine. Twenty healthy women drank 100 ml of CLJ daily for two weeks. Urine samples were obtained 2-4 hours after the last dose. Control samples were taken after a one-week period without berry consumption. Biofilm formation of 20 E. coli strains was measured at 72 hours by the polystyrene microtitre plate method. Quantitative real-time PCR analyses were performed for selected genes. Four of the 20 clinical strains produced more biofilm in urine after CLJ consumption (P < 0.05) and one produced less. Expression levels of the pga, cpxA, fimA and papF genes did not differ between bacteria grown in control urine and urine obtained after CLJ consumption, except for pga gene expression, which was reduced in one strain after CLJ (P = 0.04). It appears that the effect of CLJ in preventing UTIs is not explained by mechanisms that reduce biofilm formation or the expression of selected virulence genes of Escherichia coli in urine.
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