<p class="first" id="P1">Urinary tract infections (UTIs), the majority of which are
caused by uropathogenic
<i>E. coli</i> (UPEC), are extremely common infections that preferentially effect
women. Additional
complicating factors, such as catheterization, diabetes, and spinal cord injuries
can increase the frequency and severity of UTIs. The rise of antimicrobial resistant
uropathogens and the ability of this disease to chronically recur make the development
of alternative preventative and therapeutic modalities a priority. The major symptoms
of UTIs, urgency, frequency, and dysuria, are readouts of the autonomic nervous system
(ANS) and the majority of the factors that lead to complicated UTIs have been shown
to impact ANS function. This review summarizes the decades long efforts to understand
the molecular mechanisms of the interactions between UPEC and the host, with a particular
focus on the recent findings revealing the molecular, bacteriological, immunological
and epidemiological complexity of pathogenesis. Additionally, we describe the progress
that has been made in: i) generating vaccines and anti-virulence compounds that prevent
and/or treat UTI by blocking bacterial adherence to urinary tract tissue and; ii)
elucidating the mechanism by which anti-inflammatories are able to alleviate symptoms
and improve disease prognosis. Finally, the potential relationships between the ANS
and UTI are considered throughout. While these relationships have not been experimentally
explored, the known interactions between numerous UTI characteristics (symptoms, complicating
factors, and inflammation) and ANS function suggest that UTIs are directly impacting
ANS stimulation and that ANS (dys)function may alter UTI prognosis.
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