New study explains the link between diabetes and urinary tract infections

Massive clumps (red) of E. coli infect diabetic mouse bladder. Credit: Soumitra Mohanty

Type 1 and type 2 diabetes have lower immunity levels and more frequent infections. Karolinska Institutet in Sweden has found that people with diabetes have lower levels antimicrobial peptides psoriasin. This compromises the bladder’s cell barrier and increases the risk of infection. The study has been published in Nature Communications.

Diabetes can be caused by insulin resistance and/or insulin inactivity. Insulin is a hormone that regulates glucose levels and provides energy to cells. Type 1 diabetes is when the body stops producing insulin. Type II diabetes is when the cells are less sensitive to insulin. This contributes to high blood sugar levels. Diabetes is a common condition that can affect the health in many ways.

One effect is that it compromises your innate immune system, making many people more susceptible to frequent infections such as E.coli bacteria-caused urinary tract infections (UTIs). People with diabetes are more susceptible to developing general blood poisoning (sepsis), which is a result of infections that originate in the urinary system.

An endogenous anti-biotic

Karolinska Institutet researchers are now investigating whether glucose levels in diabetics (type 1, type 2 or prediabetes), can be linked with psoriasin. It is an endogenous anti-biotic that is part of the body’s innate immune system.

Researchers used urine, bladder cells, and blood serum samples taken from patients to analyze levels of psoriasin. This was done to ensure that the bladder mucosa is intact and protects against infection. These findings were then confirmed in mice and urinary bladder cell cells without and with infection.

“We found that high glucose concentrations decrease the levels of the antimicrobial protein psoriasin, while insulin does not,” Annelie Brauner, who was the principal investigator of the study. “People with diabetes have lower levels psoriasin which weakens cells’ protective barrier function and increases the chance of bladder infection.”

Estrogen therapy reduces bacterial populations

Professor Brauner’s research group previously demonstrated that estrogen treatment can restore the protective function bladder cells in mice and humans, and help regulate the immune response to a UTI. The researchers examined the effects of estrogen treatment on cells infected by UTIs that had been exposed to high glucose concentrations. The treatment increased levels of psoriasin, and decreased bacterial populations. This suggests that it may also have an effect on patients with diabetes.

“We now plan for deeper probes into the underlying mechanism of infections in individuals suffering from diabetes,” says Soumitra Mohanty the study’s lead author. She is also a researcher at Karolinska Institutiont. “The ultimate goal is to reduce infection risks in this growing patient group.”

The study was conducted in collaboration with the Karolinska University Hospital, Region Stockholm, Capio and Uppsala University in Sweden and Universitätsklinikum Schleswig-Holstein in Germany.

New findings may reduce the risk of infection for patients with urinary catheters

More information:
Diabetes lowers the levels of the antimicrobial protein psoriasin in the blood and increases the burden of E.coli in the urinary bladder. Nature Communications (2022). DOI: 10.1038/s41467-022-32636-y

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