Urinarytract infections ( UTIs) are a very common problem and are, in fact, the second most common type of infection in the general population.

About 90% of these infections are caused by strains of Escherichia coli, a Gram-negative bacterium found in the intestine that, under certain conditions (e.g., stress, alcohol, smoking, genetic predisposition), colonizes the genitourinary tract to varying degrees, leading to infections.

The infection occurs when the bacterium adheres to its surroundings; this adhesion is mediated by bacterial lectins that bind to receptors—sugar residues located on the cell surface. The attachment of E. coli is mediated by the fimbriae, filamentous appendages that allow the bacterium to attach to urothelial cells.

Specifically, E. coli produces two types of appendages:

– the type 1 fimbriae or mannose-sensitive (MS) fimbriae, which use mannose residues to attach themselves

– the P-type fimbriae or mannose-resistant (MR) fimbriae, which bind to a galactose disaccharide present on the surface of uroepithelial cells

Depending on the site of infection, the main infections are:

Type of infection Location of the bacteria Affected area

Urethritis Urethra

Cystitis, Bladder, Lower Urinary Tract

Prostate, Prostatitis

Kidney, Pyelonephritis, Upper Urinary Tract

A very useful approach in cases of E. coli infections is what is known as“anti-adhesion therapy,”which is effective both as a preventive measure and as a treatment during an acute infection.

The D-Mannose Plus product helps fight urinary tract infections because it contains two main anti-adhesion agents— D-mannose and cranberry— combined with vitamin C. The D-MANNOSE is a sugar that competitively inhibits the attachment of type 1 fimbriae to uroepithelial cells; this molecule binds to the bacteria, displaces them from their binding sites, and carries them into the urine stream, where they are subsequently destroyed by the body’s natural defense mechanisms.

In vitro studies conducted on epithelial cells isolated from women with recurrent UTIs have demonstrated the effectiveness of D-mannose in preventing the adhesion of type 1 fimbriated E. coli; 73 strains of E. coli were isolated, and 66 of these were tested to evaluate their adhesion following treatment with D-mannose. It was found that this sugar inhibited adhesion to the vaginal epithelium in 42% of the strains isolated from a group of volunteers and in 50% of 11 other E. coli strains. (A) Urinary concentrations of D-mannose in the volunteers showed an inverse correlation between low concentrations of this sugar and an increased incidence of infections. The mechanism of action of D-mannose works in conjunction with the action of PROANTHOCYANIDINS ( PACs) from cranberries, which inhibit the growth of P-fimbriae-bearing E. coli by binding to the galactosidic residues on the surface of uroepithelial cells.

Recent studies have shown that cranberries also possess a high anti-adhesive capacity; this capacity was measured both in vitro and in vivo by collecting urine samples from certain subjects first thing in the morning. After supplementation with 36 mg of PACs and, subsequently, 108 mg, bacterial adhesion decreased significantly and in a dose-dependent manner. (B) Vitamin C rounds out the product’s profile because it lowers the pH, creating an inhospitable environment for bacterial growth. A positive aspect of the D-Mannose Plus product is the high dosages of each component; this choice is based on the assumption that both D-mannose and cranberry act through a dose-dependent mechanism, and therefore the amounts provided are sufficient to ensure an effective and rapid action.
 

MEDIUM-RANGE TONES OF Ingredients

Ingredients per daily dose (4 tablets of 1.1 g each)

Ingredients Per Daily Dose

D-Mannose 2500 mg

Cranberry fruit extract 432 mg

of which proanthocyanidins 108 mg

Vitamin C 320 mg (400% NRV)

INDICATIONS FOR USE

During the acute phase, 4 tablets per day are recommended for 3 days; during the maintenance phase, continue with 2 tablets per day for 4 days. One important point to note is the frequency of administration; the anti-adhesive effect is also time-dependent—that is, maximum efficacy is achieved by dividing the maximum dose into multiple daily administrations, since taking 4 tablets per day provides full 24-hour coverage.

If necessary, the product can also be used to prevent any recurrence; in this case, 2 tablets a day are sufficient.

BIBLIOGRAPHY

1. SCHAEFFER, A.J., CHMIEL, J.S., DUNCAN, J.L., et al. J. Urol. 1984, 131 (5), 906–10
2. LAVIGNE J.P., BOURG G., COMBESCURE C. , et al. Clin. Microbiol. Infect. 2008, 14 ( 4), 350-5