Incontinence medication response relates to the fe

Authors: Krystal J ThomasWhite Evann E Hilt Cynthia Fok Meghan M Pearce Elizabeth R Mueller Stephanie Kliethermes Kristin Jacobs Michael J Zilliox Cynthia Brincat Travis K Price Gina Kuffel Paul Schreckenberger Xiaowu Gai Linda Brubaker Alan J Wolfe

Publish Date: 2015/09/30

Volume: 27, Issue: 5, Pages: 723-733

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Abstract

Many adult women have resident urinary bacteria urinary microbiome/microbiota In adult women affected by urinary urgency incontinence UUI the etiologic and/or therapeutic role of the urinary microbiome/microbiota remains unknown We hypothesized that microbiome/microbiota characteristics would relate to clinically relevant treatment response to UUI medication per osAdult women initiating medication treatment orally for UUI and a comparator group of unaffected women were recruited in a tertiary care healthcare system All participants provided baseline clinical data and urine samples Women with UUI were given 5 mg solifenacin with potential dose escalation to 10 mg for inadequate UUI symptom control at 4 weeks Additional data and urine samples were collected from women with UUI at 4 and 12 weeks The samples were assessed using 16S ribosomal RNA rRNA gene sequencing and enhanced quantitative urine culturing The primary outcome was treatment response as measured by the validated Patient Global Symptom Control PGSC questionnaire Clinically relevant UUI symptom control was defined as a 4 or 5 score on the PGSCDiversity and composition of the urinary microbiome/microbiota of women with and without UUI differed at baseline Women with UUI had more bacteria and a more diverse microbiome/microbiota The clinical response to solifenacin in UUI participants was related to baseline microbiome/microbiota with responders more likely to have fewer bacteria and a less diverse community at baseline Nonresponders had a more diverse community that often included bacteria not typically found in respondersKnowledge of an individual’s urinary microbiome/microbiota may help refine UUI treatment Complementary tools DNA sequencing and expanded urine culture provide information about bacteria that appear to be related to UUI incontinence status and treatment response in this population of adult womenWe kindly thank Mary Tulke RN and Bozena Zemaitaitis for their assistance with participant recruitment and sample collection and Kathleen McKinley MT ASCP for her clinical microbiology contributions We acknowledge and thank the Loyola University Chicago Health Sciences Division’s Office of Informatics and Systems Development for their expertise and for computational resources used in support of this researchThis study was supported by a grant from the Falk Foundation LU202567 by NIH grant R21DK09743501A1 and by Astellas Scientific and Medical Affairs ASMA Wolfe PI and is registered at wwwclinicaltrialsgov as NCT01642277 Loyola University Chicago Stritch School of Medicine’s research computing facility was developed through grant funds awarded by the Department of Health and Human Services as award number 1G20RR03093901 The following reagent was obtained through BEI Resources NIAID NIH as part of the Human Microbiome Project Genomic DNA from Microbial Mock Community A Even Low Concentration HM782D Our funding sources had no role in design and conduct of the study collection management analysis and interpretation of the data preparation review or approval of the manuscript ASMA was given a courtesy review

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