[ad_1]
“I’m losing a lonely battle with the medical community as these UTIs won’t go away.”
“I find that this affects every aspect of my life.”
These are the experiences of real women who suffer from frequent urinary tract infections (UTIs).
They’re one of the most common bacterial infections — more than half of all women and one in five men will have a UTI at some point in their lives.
And for those with recurring infections (two or more in six months or three in a year) quality of life can really take a nosedive.
The constant pain often means missing work or social activities, poor sleep, anxiety about sex and higher levels of depression.
Antibiotics have been the only weapon in our arsenal for decades, but with an alarming rise in global antimicrobial resistance researchers are trying to develop new treatments.
“We are terrified. Because we don’t have any new antibiotics coming in,” said urologist Bob Yang, who is based in the UK.
“Because the mainstay of treatment is low-dose antibiotics once a day, every day we’re essentially breeding the next generation of treatment resistant bacteria.”
But a pineapple-flavoured vaccine that’s not yet approved for use in Australia could mark a new chapter in this story.
It’s called MV140 and it contains heat-inactivated bacteria from four of the major species that cause UTIs: Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis and Proteus vulgaris.
But this is a needle-free vaccine.
The vaccine is stored in the fridge and sprayed under the tongue every day for three months to prevent UTIs from occurring.
Why under the tongue? Because when you stimulate the oropharyngeal system (the base of your tongue, your tonsils, the roof of your mouth) there’s a strong immune response in the bladder, said Dr Yang, who has worked as an investigator with the company developing the vaccine.
Early evidence of safety and effectiveness
Up until now we’ve only seen short-term studies on MV140.
A 2022 trial showed women who received the vaccine had on average 0 to 1 UTIs in a nine-month period, while those who had a placebo had on average three infections in the same period.
But for the first time, a long-term observational study has been completed by clinicians at the Royal Berkshire Hospital in Reading, England.
The small study’s findings were presented at the European Association of Urology Congress in Paris on April 6 but are yet to be peer reviewed.
Of the 72 women and 17 men who participated in a trial of MV140, 54 per cent remained UTI-free nine years after receiving the drug, the research team said.
The remaining 46 per cent had fewer, less severe UTIs and some reported they were able to just drink more water to resolve the infection. Some, however, did need to take a course of antibiotics due to a ‘breakthrough‘ infection.
Around 40 per cent of participants had repeat doses of MV140 one or two years after initial treatment, some because of breakthrough infections, some just as a preventative measure.
“But importantly we wanted to test the safety of this vaccine and we showed that in nine years there were no long-term side effects” said Dr Yang, who co-led the research.
Research by the same team released last month also found patients reported higher energy levels, the ability to do more day-to-day activities and higher emotional wellbeing after receiving MV140.
An overlooked condition
Monash University immunologist Malcolm Starkey, who is developing immunotherapies for UTIs, said the results were promising.
He said targeting the immune response rather than specific bacteria that cause UTIs could take some of the guesswork out the equation.
“We don’t necessarily know which antibiotics to use in any given case as its not always clear what particular infection is causing the symptoms,” Dr Starkey said.
“The idea of having a vaccine that can have these long-term effects is a real game-changer.”
There’s keen interest internationally to develop a UTI vaccine, with other types being tested in the United States.
A rapid dissolving tablet that doesn’t require refrigeration, and a vaccine that’s administered directly into the cells of the bladder provided protection against recurrent UTIs when tested on mice.
Both of these treatments are the work of researchers at Duke University, but neither have reached the human clinical trial stage.
Dr Starkey said researchers should now test the efficacy of MV140 on more complex groups including immunocompromised people, children and those with chronic UTIs.
UTIs can become chronic when bacteria from the urine embed in the bladder lining and effectively hide from antibiotics.
It’s a largely unrecognised condition and many never receive an accurate diagnosis.
“Unfortunately UTIs don’t get enough attention and I think one of the reasons is because it mostly affects women,” Dr Starkey said.
“It’s also a bit of a warrior’s disease, people can suffer with this for a very long time and it’s a bit of a taboo topic.
“You go to a family barbecue and people talk about melanomas or breast cancer screening but they don’t tend to talk about urine.”
Dr Starkey said trying to get diagnosed for a UTI was a “mess” right now as doctors relied on bacterial culturing techniques developed 50 to 60 years ago.
On top of this, we’re only just starting to understand the microbiome of the bladder.
He said patients could also get a bit lost in the system and unlike in the UK and US, there are no specialised UTI clinics in Australia that bring together urologists, gynaecologists and microbiologists.
“These multidisciplinary clinics are really needed to manage complex cases.”
What next?
MV140 has not been approved in most countries including Australia, the UK and the US.
Doctors in Australia can however apply to prescribe it to a specific patient through the special access scheme or apply to become an authorised prescriber for multiple patients.
But this means it cannot be offered widely and a three-month treatment costs $320.
There is currently no application before the Therapeutic Goods Administration to approve MV140.
Patient advocacy organisation Chronic UTI Australia said they’ve heard mixed responses about the effectiveness of MV140 when used by those with chronic, embedded UTIs.
“We have several anecdotal reports from chronic UTI patients who have had one or more courses of [MV140] while also being treated with full-dose antibiotics for a protracted period, who found they experienced fewer UTI flare-ups while taking the treatment,” the group said.
Dr Yang and his colleagues are now expanding their trials to people with spinal injuries who commonly suffer from bladder dysfunction and recurring infections.
“This is very exciting for us. If this is effective we could be removing one of the biggest killers for spinal injury patients in the world.”
And finally — why pineapple flavour?
“Just because it tastes nice.
“But if you don’t like pineapple I’m sorry.”
Get the latest health news and information from across the ABC.
|
Sources 2/ https://www.abc.net.au/news/health/2024-04-11/vaccine-treatments-for-urinary-tract-infections-uti-antibiotic/103684972 The mention sources can contact us to remove/changing this article |
[ad_2]