Immunomodulation therapy offers molecular strategies to treat rUTI
Immunotherapy is a more accurate term to describe these new UTI ‘vaccines.’
Recurrent urinary tract infection in women is associated with widespread morbidity, massive antibiotic use, increasing antibiotic resistance and significant costs. Patients with rUTIs experience significant morbidity from current infections and a higher risk of side effects from multiple courses of antibiotics.
“The time is now to embrace vaccination for UTI as we enter the post-antibiotic era,” said R. Christopher Doiron, MD, MPH, FRCSC, assistant professor in the department of urology at Queen’s University in Kingston, Ontario, Canada.
In the State-of-the-Art Lecture, “The UTI Vaccine,” Dr. Doiron led with a question of semantics, contending that “vaccine” can be equated with viruses, such as COVID-19 and smallpox, which was eradicated in 1980 because of vaccines. “But UTIs are not smallpox. We’ve come a long way since the turn of the 19th century, when the term ‘vaccine’ was coined,” he said. Rather, UTI immunotherapy is a more accurate term that reflects the power of these new UTI therapies to modify the immune response, he said.
“In acute uncomplicated UTI, patients are infected with a uropathogen and antibiotic resolves that process. However, there is a group of susceptible patients in which an immune imbalance occurs,” he said. “UTI triggers an immune imbalance and a cycle of recurrent infection. Yet, these patients also have an immunologic susceptibility that is targetable with immunomodulation.”
Dr. Doiron presented an overview of the current UTI immunomodulation landscape for the rUTI population, including OM-89 (UroVaxom), MV140 (Uromune) and Solco-Urovac as well as ExPECV4 and ExPECV10, which are currently in phase III clinical trials and perhaps less relevant to the rUTI population because they are more targeted toward preventing extraintestinal pathogenic E. coli disease, such as E. coli bacteremia, he said.
With these new therapies for rUTI, questions of science remain, including whether these immunologic therapies offer long-term immunologic memory, whether a booster is necessary and, if so, when and how often they should be administered and if earlier vaccination would benefit this susceptible patient population. “Regulatory approval is challenging with bacterial-based preparations,” Dr. Doiron said. More high-quality randomized controlled trials are needed.
Still, “these challenges should not stop us from embracing the benefits these therapies could provide our patients today,” he added. AUA Guidelines mention UTI vaccines, but don’t provide recommendations. “Given how much these patients suffer, we could do better to advocate for this important women’s health issue.”
