Intravesical Lactobacillus rhamnosus GG Alters Urobiome Composition and Diversity Among People With Neurogenic Lower Urinary Tract Dysfunction

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci23-00004 · Published: July 1, 2023

Spinal Cord Injury Urology Gastroenterology

Simple Explanation

This study explores how introducing Lactobacillus rhamnosus GG (LGG) directly into the bladder affects the types and amounts of bacteria present in the urine of adults with spinal cord injuries or diseases who use intermittent catheterization to manage their bladder function. Urine samples were taken monthly when participants didn't have symptoms. Additional samples were taken right before and 24-48 hours after LGG was introduced when participants experienced symptoms like cloudier or foul-smelling urine. The study found that after LGG was introduced, there was a decrease in the amount of Escherichia/Shigella bacteria and a change in the overall bacterial diversity in the urine.

Study Duration

18 months

Participants

26 participants (SCI/D = 23; multiple sclerosis = 2; spina bifida = 1)

Evidence Level

Phase 1 clinical trial, quasi-experimental pre-post study

Key Findings

1
The urobiomes were characterized by four dominant phyla (>1%): Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria.
2
Post-LGG samples were associated with a decline in Escherichia/Shigella predominance (p < .001) and altered bacterial diversity (p < .05).
3
Among people with SCI/D who use IC, intravesical LGG alters the bacterial composition and diversity of the urine ecosystem, potentially disrupting the uropathogenic urobiome.

Research Summary

This pilot study investigated the impact of intravesical Lactobacillus rhamnosus GG (LGG) on the urobiome of adults with neurogenic lower urinary tract dysfunction (NLUTD) who use intermittent catheterization (IC). The study found that LGG instillation led to a decrease in Escherichia/Shigella abundance and altered bacterial diversity in the urine ecosystem. These findings suggest that intravesical LGG may disrupt the uropathogenic urobiome in individuals with NLUTD, potentially impacting urinary symptoms and urinary tract infections.

Practical Implications

Potential Biotherapeutic Approach

Intravesical LGG instillation could serve as a biotherapeutic approach to positively impact NLUTD-related urobiome dysbiosis.

Reduced Uropathogen Abundance

LGG instillation significantly reduced the abundance of Escherichia/Shigella and Aerococcus, suggesting a mechanism to combat uropathogens.

Altered Bacterial Diversity

Changes in bacterial diversity post-LGG instillation indicate a substantive shift in the urobiome, potentially leading to improved urinary health.

Study Limitations

1
Small sample size limits analysis across covariates and clinical phenotypes.
2
Relevance of detecting organisms associated with specific phenotypes is unknown.
3
Lack of a standardized definition for UTI among this population complicates characterization of the NLUTD-UTI phenotype.

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