The role of D-mannose and proanthocyanidins in cranberries in the prevention of recurrent urinary tract infections.

Introduction. Prevention of urinary tract infections (UTI) is an urgent problem due to their high prevalence. Regular use of antibiotics, especially when recurrent urinary tract infections occur, contributes to the formation of resistant strains of microorganisms and the development of antibiotic cross-resistance. Thus, the relevance of finding alternative approaches for the treatment and prevention of such diseases is increasing. Materials and methods. Literature review from eLibrary.ru and PubMed revealed insufficient study of the use of D-mannose and proanthocyanidins of cranberry. Results. D-mannose is a simple sugar that has structural similarity to the mannose residues of uroplakin-1a, which coats the surface of urothelial umbrella epithelial cells. D-mannose is able to saturate FimH-adhesins, which prevents E. coli attachment mediated by FimH and type 1 fimbriae through a competitive inhibition mechanism, and excrete pathogens with urine. Cranberry consumption also inhibits bacterial adhesion. Although proanthocyanidins contained in cranberries do not have their own antibacterial activity, they prevent the attachment of uropathogenic E. coli by blocking the P-type fimbriae. Knowledge of the mechanisms of action of D-mannose and proanthocyanidins of cranberry, which exert their anti-adhesive effect by interacting with different types of fimbriae, suggests that the combination of these substances can bring much greater benefit and maximally block the adhesion of pathogenic bacteria. Conclusion. The published results of clinical studies have confirmed the efficacy of prescribing D-mannose and cranberry proanthocyanidins for the prevention of UTIs, but further reliably designed clinical trials of the combined use of different prophylactic methods to control urinary tract infection are needed.