Therapies in early development for the treatment of urinary tract inflammation

ABSTRACT

Introduction: Urinary tract inflammation is a very common clinical condition. It is caused by several pathogens and antibiotic treatment is the mainstay of therapy. Increasing antimicrobial resistance and high recurrence rates represent a challenge. Consequently, there is an unmet need for new therapeutic options.

Areas covered: The authors discuss the rationale of emerging management strategies and current experimentation. Furthermore, they focus on both acute and recurrent urinary tract infections (UTIs) and examine a range of therapeutics, including new antibiotics, vaccines, mannosides, hyaluronic acid, probiotics, immunomodulant agents and novel compounds derived from nanotechnology.

Expert opinion: Basic science studies have elucidated the pathogenesis of UTIs and built up the ground for the development of new therapies. Evidence is mainly derived from animal studies on murine models of bacterial cystitis. However, clinical trials are scanty and cannot provide us with robust evidence. Hetereogeneity and virulence of uropathogens pose a threat that scientists and clinicians are struggling to overcome.

KEYWORDS:

• Early development
• novel treatments
• urinary tract inflammation
• uropathogens

Article highlights

• Inflammation of the urinary tract is most often the result of urinary tract infection (UTI).

• UTIs are caused by a range of bacteria. In the vast majority of the cases, Gram-negative uropathogenic Escherichia coli (UPEC) is involved.

• Animal models have been essential to investigate pathogenic mechanisms and potential treatment strategies.

• Because of the high recurrence rates and increasing antimicrobial resistance, new therapeutic options have been developed. These include new antibiotics, vaccines, mannosides, hyaluronic acid, probiotics, immunomodulant agents, and new compounds derived from nanotechnology.

• Data available on new compounds derive mainly from preclinical studies. Only new antibiotics are progressing to phase III trials.

The box summarizes key points contained in the article.

Financial & competing interests disclosure

I Giarenis has received funding from Astellas for travel expenses. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.