Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS)
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To correlate the presence of fungi with symptom flares, pain and urinary severity in a prospective, longitudinal study of women with IC/BPS enrolled in the MAPP Research Network.
Flare status, pelvic pain, urinary severity, and midstream urine were collected at baseline, 6 and 12 months from female IC/BPS participants with at least one flare and age-matched participants with no reported flares. Multilocus PCR coupled with electrospray ionization/mass spectrometry was used for identification of fungal species and genus. Associations between “mycobiome” (species/genus presence, relative abundance, Shannon’s/Chao1 diversity indices) and current flare status, pain, urinary severity were evaluated using generalized linear mixed models, permutational multivariate analysis of variance, Wilcoxon’s rank-sum test.
The most specific analysis detected 13 fungal species from 8 genera in 504 urine samples from 202 females. A more sensitive analysis detected 43 genera. No overall differences were observed in fungal species/genus composition or diversity by flare status or pain severity. Longitudinal analyses suggested greater fungal diversity (Chao1 Mean Ratio 3.8, 95% CI 1.3–11.2, p = 0.02) and a significantly greater likelihood of detecting any fungal species (OR = 5.26, 95% CI 1.1–25.8, p = 0.04) in high vs low urinary severity participants. Individual taxa analysis showed a trend toward increased presence and relative abundance of Candida (OR = 6.63, 95% CI 0.8–58.5, p = 0.088) and Malassezia (only identified in ‘high’ urinary severity phenotype) for high vs low urinary symptoms.
This analysis suggests the possibility that greater urinary symptom severity is associated with the urinary mycobiome urine in some females with IC/BPS.
KeywordsInterstitial cystitis Bladder pain syndrome Mycobiome Fungal Flares
JCN, AS: protocol development, data management, data analysis, and manuscript writing/editing. JRL: protocol development, data management, data analysis, and manuscript editing. CM: protocol/project development, data collection and management, data analysis, and manuscript writing/editing. AvanB, GDE: protocol development, data collection and management, data analysis, and manuscript writing/editing. JTA, ALA, JK: protocol development, data analysis, and manuscript editing. SS: protocol/project development, data collection and management, data analysis, and manuscript editing. JEK, BS, JH: data collection and management, data analysis, and manuscript editing.
The authors declare that this project was supported (including salary support) by peer reviewed research grants from the US National Institutes of Health: NIDDK: U01DK103271 (JCN, JEK, BS, JH, GDE), U01DK082316 (AS, JRL), U01DK082333 (AVB), U01DK103260 (JTA, ALA, JK), U01DK082315 (SS).
Compliance with ethical standards
Conflict of interest
CM is an employee of the NIH/NIDDK. The authors report no other potential conflict of interest.
Ethical responsibilities of the authors
The authors agree to the conditions outlined in the submission instructions.
Written informed general consent for specimen procurement and data analysis was obtained from all individual participants included in the study.
Research involving human participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Research involving animals
This article does not contain any studies with animals performed by any of the authors.
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