SIGN UP TODAY FOR A NEW UTI TRIAL
Loyola University and Live UTI Free are recruiting women now for a study on the microbes present in the urinary tract that may be associated with recurrent urinary tract infections. Participation is easy – there’s no travel required, and you just need to send in the occasional urine sample.
Dr. Alan Wolfe, a professor of microbiology and immunology at Loyola University, talks with us about what the trial is intended to discover and how you can join in and help researchers learn more about the nature of frequent UTIs – and potentially help develop more personalized, effective treatments for them.
Click here if you’re interested in participating in this study.
You can learn more about Live UTI Free by clicking here.
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Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continents. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors and a welcoming community of patients, physicians, and caregivers. All available at NAFC.org.
Welcome back to another episode of Life Without Leaks. With us today is Dr. Alan Wolfe, who’s a professor of microbiology and immunology at Loyola University in Chicago. And today he’s here to talk with us about a study that’s going to be of real interest for people who suffer from frequent urinary tract infections.
So welcome Dr. Wolfe. Thank you for joining us.
Dr. Wolfe: You’re quite welcome.
Bruce Kassover: So tell me, what is the study about?
Dr. Wolfe: It’s a study where we’re going to recruit a little over a thousand women. It’ll have two groups. One group will be individuals that suffer from recurrent UTIs, and then a control group that does not suffer from recurrent UTIs.
We’re going to obtain urine samples from them, and we’re going to sequence the microbial communities that are present in their urine. The idea would be to see whether or not we can identify patterns in the microbial communities that are present in their urinary tracts and the demographics and symptoms of the individuals.
For example, are there differences in the community between those individuals that are affected by recurrent UTIs and those individuals that are unaffected?
Bruce Kassover: So now when you say microbial communities, for those who are listening who might not be familiar with what that means, we’re talking about essentially the bacteria that are in the urinary tract. Does that sound right?
Dr. Wolfe: It’s mostly correct. The way in which we’re going to sequence the microbial DNA will allow us to detect not just bacteria, but also fungi, protests, which are small, like, protozoa. We can also detect viruses. And so it’s, it’ll be the entire community that’s present in, in all these individuals’ urine samples.
Bruce Kassover: So now, is it largely bacteria that’s responsible for UTIs or could it be any of these other things that you’re talking about as well?
Dr. Wolfe: So presently the thought is the dogma is that e-coli causes the vast majority of urinary tract infections because of the way bacteria are detected in clinical microbiology labs.
The ratio, or that percentage of UTIs that are likely caused by e coli, is, based upon our work, is highly inflated. So you’ll see numbers like between 70% and 90% of all urinary tract infections. And here we’re talking both recurrent UTIs and, you know, sporadic UTIs, that over 90%, up to 90% are caused by, e coli, which is a bacterium.
Our numbers suggest it’s more like 50 percent. There are other bacterial species that are considered to be pathogens of the urinary tract, what are called uro pathogens, and that includes organisms like Klebsiella and Proteus, particular species of Staphylococcus. These are all bacteria. The possibility that some urinary tract infections are caused by fungi like yeast, particular types of yeast. One very typical yeast is called Candida, it’s quite possible that it causes UTIs. There are other fungi that might be the cause of urinary tract infections. And I could tell you I don’t think anybody knows anything about whether viruses or protists contribute to urinary tract infections.
Bruce Kassover: So you said you’re looking for a thousand women to participate. Is there a particular age range that makes sense?
Dr. Wolfe: They have to be at least 18 years old.
Bruce Kassover: At least 18. Okay. So since you’re collecting urine, do you want them to be local to the Chicago area?
Dr. Wolfe: No, anybody in, um, the lower 48 states of the United States.
So what will happen is, women will go to the website of Live UTI Free, who is the other half of this research, and if they’re interested, they’ll answer a questionnaire to determine whether or not they qualify. If they pass muster, then they will get a package in the mail which will include the materials necessary to provide their urine sample along with very detailed instructions on how to obtain that sample and what to do with that sample so that it arrives intact at Loyola University so that we can, we can analyze the sample.
Bruce Kassover: Now the one thing that might give some people hesitancy, it sounds a little inconvenient to actually have to pee in a cup. I mean, it’s messy and not all that pleasant. Is that really what it entails?
Dr. Wolfe: No, most of these women, if not all of them, have gone to the clinician and they’ve been asked to go into the bathroom and they’re given a blue cap cup and they have to, they have to urinate in the toilet for a little while, and then they have to urinate into the cup, and then they have to put the cup back, the top back on the cup and finish urinating. And it’s called “midstream voided urine” or the quote unquote “clean catch”. We, by the way, call it the “not-so-clean catch,” because if you’ve ever tried to do this, you realize that you probably end up with half of the urine on your hands and it’s pretty messy. Well, that’s not what’s going to happen here.
There is a urinal that we will be, when you get your package in the mail, if you are included in the study, that urinal device is called a Peezy. It’s capital, P-E-E-Z-Y, and it has a funnel that’s placed so that the urine stream goes into that funnel. There’s a sponge that when it, when it gets wet, it expands.
So the first, while it’s getting wet, the first part of the flow ends up in the toilet, but once the sponge expands, it diverts the urine into what’s essentially a little plastic test tube. When that gets filled, the rest of the urine goes into the toilet. When you’re all done, you unscrew the test tube from the urinal device, you throw the urinal device away, you put, there’ll be a little bit of liquid that you’ll put into the urine – that’s to preserve it – and then you put a cap on. And there’ll be a mailer, you know, a padded mailer, and you put the tube into the mailer and you put that in the mail, and it comes to Loyola.
The protocol, the description of how you do all of this is provided, will be provided on the website and also in the package that you receive in the mail. So it’ll be point by point-by-point, telling you how to make sure that, you know, you get a, a sample that is labeled properly and intact at the shipping dock here at Loyola so my team can pick it up and process it.
Bruce Kassover: And like the name implies, easy-peasy.
Dr. Wolfe: That’s exactly why it was named that way.
Bruce Kassover: I love the branding. It’s great, and it certainly, it certainly sounds a lot more comfortable than, like you said, having to do it the old-fashioned way.
Dr. Wolfe: Yes. I had to do that not too long ago, and for someone who’s supposed to know how to do it, I found it to be really hard, I mean, the old pee-in-a-cup. Yeah. Particularly problematic for people that are a little unstable. People that are, I mean, like, you know, ask a pregnant woman to pee in a cup without splashing all over the place could be a real problem. So when we discovered the Peezy, we, I actually have a direct link to the president of the company and we’ve done studies with it and find that it is not terribly difficult to use, it reduces contamination, it certainly standardizes the collection method.
Bruce Kassover: Okay. Now, you, you mentioned how it’s particularly in interested in people who have frequent UTIs. What counts as somebody who has frequent UTIs, how, what sort of frequency are we talking about?
Dr. Wolfe: The current definition that my clinical colleagues use is at least two u UTI episodes in six months or three within a year.
Bruce Kassover: Okay, I think that that sounds like it would counts as frequent. Certainly it would be incredibly annoying if you have it with, that sort of frequency.
Now, the results of the study are, the aim of this study is not actually to generate some sort of immediate type of treatment plan or anything for these people; it’s so that they can provide information that can be of benefit for further studies. That, does that, does that sound about right?
Dr. Wolfe: That’s absolutely correct. We’ve done a number of studies, smaller studies that have provided us with some idea of, a pretty good idea of what bacteria, and to some degree, viruses and fungi are present in the typical urinary tract of an adult female who isn’t seriously ill.
And by seriously ill, I mean chronic kidney disease or something like that. We know what organisms, to a large extent, what we expect to see in individuals that don’t have symptoms. Individuals with urinary tract infections, recurrent urinary tract infections, kidney stones, urgency urinary incontinence, a whole slew of different lower urinary tract disorders, but they’re all relatively small.
This study is designed to provide a large sample size, right? Over a thousand women. I think it’s somewhere in the neighborhood of 700 who do have symptoms and 300 that don’t. The individuals that do experience recurrent UTI episodes, were asking them to give us two samples, one sample while they’re suffering from an episode of infection and one sample when they’re not having symptoms.
The controls, of course, have no symptoms, so we’re only asking for one. We’re also asking for a small group of women to sample themselves every day. These would be women with recurrent UTIs to sample themselves every day for, can’t remember, several weeks, and then they’re going to be asked to answer a very, very detailed questionnaire.
So in the end, what we’re going to do is compare the questionnaire data, information about the individuals themselves. Right? How many episodes do they have, how old they are, a whole variety of different relevant bits of information about that individual and their symptoms or lack of symptoms. And we’ll be able to compare them to the microbial communities that we identify within their urine samples.
This will give us the opportunity to see patterns. Are the organisms different in individuals with recurrent UTIs when they have an episode versus when they don’t have an episode? Or maybe it’s very similar? Are the communities in individuals with recurrent UTIs different from those in the asymptomatic controls? Is there any pattern associated with age with the particular type of symptoms they experience with any medications that they take?
This data set will then allow us to develop hypotheses that could be tested with the goal ultimately of sorting individuals with recurrent UTIs. Perhaps, and this is my opinion, that there isn’t such a thing as recurrent UTI.
Rather, there are lots of different types of recurrent UTIs. There’s no such thing as cancer. There are lots of different cancers. There are different types of breast cancer, right? If you treat somebody with a treatment for a particular type of breast cancer and, and an individual has a different breast cancer, the treatment won’t work.
Today, all recurrent UTIs are lumped together. They have not been separated, and I fear that clinicians are attempting to cure a basket of apples, oranges and bananas, and they’re failing because they don’t really understand which form of recurrent UTI we’re looking at. And so this study will provide some of the early information that’ll allow us to sort recurrent UTIs into appropriate baskets.
That will then allow us to begin thinking about, well, if we have a particular type of recurrent UTI, what treatments could we use on that particular type of recurrent UTI versus another one. Ultimately, clinicians could develop algorithms that have a high probability of success because the treatments then will be considerably more focused and therefore likely more successful.
Bruce Kassover: Are participants going to be compensated in any way for this?
Dr. Wolfe: They are not. We’re asking them to do this as a civic duty. They will be provided with, sort of, study updates. They, they will not be given their particular microbial community, but they will also be, at the end of the study, they will be provided with a summary of what we found overall.
I’ve been told from my clinical collaborators that women with recurrent UTIs have a tendency to participate because, as we pointed out earlier, this is a big problem for individuals that are affected and they would like to have clinicians have a better understanding so that they can get treated properly.
Bruce Kassover: Yeah, it’s more than civic duty. I think it is self-interest. They might not be… result in a cure for you right this minute, but if it helps down the road, it’s going to help you and a lot of other people.
Dr. Wolfe: I completely agree with you.
Bruce Kassover: So tell me this, do you have a deadline for when you want people who are interested in participating to reach out?
Dr. Wolfe: The website for recruitment is going to go live shortly. I’m not exactly sure of the date, but we kind of expect to be able to start recruiting individuals, I believe next month.
Bruce Kassover: So we’re talking about March of 2023?
Dr. Wolfe: Exactly right. And, you know, so the website is the Live UTI Free website. It’s an organization run by, led by Melissa Kramer.
It’s a resource that many of your listeners might be familiar with, but it’s dedicated to pulling together the latest, most accurate information about recurrent UTIs.
Bruce Kassover: So for anybody who has a pen handy or just has a good memory, that’s LiveUTIFree.com. That’s L-I-V-E-U-T-I-F-R-E-E dot com. Does that sound right?
Dr. Wolfe: It does.
Bruce Kassover: And we are going to put a link to that in the show notes as well, so you don’t have to have a good memory. You just have to click on that.
Well, Dr. Wolf, that sounds great. And I really do hope that this podcast reaches a good number of women who are interested in really helping solve a lot of the riddles that are involved with UTIs.
And I want to thank you for your participation in this study and your participation in this podcast. So thank you for joining us.
Dr. Wolfe: Absolutely my pleasure. And I hope that this study reaches its aspirations. I think it’ll be a really, well, the plan is for it to be very, very valuable to the community.
Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at NAFC.org.
Please help me. I have had every single bacterial uti known to mankind. Have had about 30 uti’s.. I live in Chicago IL on NW side. Am on methenamine but STILL got a uti. I live independently in a retirement home and get uti’s from those in assisted living who are among us. I now live in isolation, taking my meals up to my apartment to eat, not participating in any activities, not interacting with another human in the place to stay safe! My golden years are ruined now! Had hysterectomy, sling was installed too tight and left in place 4 months, then slit (it was supposed to be extended). Bladder fell out into my hands! Went to Dr. Brubaker at Loyola who performed urgent surgery of colpocleisis. Did fine job BUT urologist moved urethra too far from bladder and I am incontinent past 12 years. I wear Depends and add a pad, which I change often. Cecilia