A New Vaccine Could Be a Game Changer for People With Recurrent UTIs

Recurrent urinary tract infections (rUTIs) can become problematic to treat, especially when bacteria develop resistance to the commonly prescribed antibiotics, an issue that the new MV140 vaccine hopes to solve.

A new UTI vaccine is a positive step forward for global health, especially for women. UTIs are the most common outpatient infection with 50 percent to 60 percent of women experiencing them. For some women, the infection may be recurrent. In fact, 30 percent to 44 percent of women with recurrent UTIs (also known as acute cystitis) experience another episode, often within three months.

The primary treatment for recurrent UTIs is long-term antibiotic use, which can interfere with the patient's gut microbiome and increase the risk of antimicrobial resistance. This happens when bacteria are repeatedly exposed to antibiotics, killing off the susceptible bacteria but leaving behind the resistant few.

Aside from antibiotic effects, rUTIs have several other consequences, such as losing time from work, high levels of discomfort and long-term effects on the bladder, including hypersensitivity.

Advancements in vaccines

At present, more than one UTI vaccine is being developed. One showing great promise is the novel MV140 vaccine, brand name Uromune. The two other main UTI vaccines are Uro-vaxom, which is taken orally in pill form, and Urovac or Solco-Urovac, administered into the vagina. Both are available in the United Kingdom and some other countries, but not in the United States.

The Uromune vaccine is delivered sublingually, with a spray under the tongue. This is carried out on a daily basis for three months or more to create immunity.

It is a vaccine delivery system based on allergy vaccines, as the area underneath the tongue is immune-sensitive, explained J. Curtis Nickel, M.D., urologist and professor of urology at Queen's University in Ontario, and the principal investigator for Uromune in Canada.

"It [under the tongue vaccine] builds up innate [trained] immunity and an adaptive immunity for specific bugs and their relations, as bugs look a lot alike in some families," he explained.

If a person's first UTI is severe, their body might generate a protective immune response to help prevent recurrence in the future, explained Betsy Greenleaf, D.O., the first board-certified female urogynecologist in the United States. However, the body often isn't able to generate the necessary antibodies, and this is where the vaccine comes in.

"The idea behind the vaccines is to stimulate the immune system to mount a response to the most common causative bacteria of UTIs," Greenleaf said.

Many vaccines are designed to treat viruses such as the flu or COVID-19, but this vaccine is polybacterial and builds immunity against four types of bacteria: Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis and Proteus vulgaris.

The Uromune vaccine

Results in worldwide studies for the MV140 vaccine have been positive so far. One 2019 study looked at 784 patients, all with a history of three or more uncomplicated UTIs in the 12 months prior to receiving the vaccine. The research indicated that three months after Uromune, 44.1 percent had zero urinary tract infections, and 27.6 percent had one. After six months, the results were zero urinary tract infections in 32.3 percent, and one in 32.4 percent.

As a sufferer of recurrent UTIs, Greenleaf is hoping to get the Uromune vaccine herself, although she doesn't think it would eliminate the risk of UTIs entirely because some bacteria in the urinary tract would not be affected by the vaccine. However, she believes the most significant impact of the vaccine would be positive: a decreased risk of the development of antibiotic-resistant bacteria.

It's not yet known when the Uromune vaccine might be available for general use in the U.S., as approval from the Food and Drug Administration (FDA) can take some time. However, it is available under the compassionate use program, which gives a patient access to a treatment that is currently being investigated when there is a medical need.

The vaccine has gone to Health Canada for approval, and the European Union may also review Uromune as it has a mandate to find alternatives to antibiotic use. Nickel believes this international pressure will encourage the FDA to seriously consider the Uromune vaccine.

He said the issue of recurrent UTIs in patients is not perceived to be a major healthcare problem. One of the benefits of the vaccine is that it could challenge this perception, especially if it is rolled out globally.

Greenleaf said she believes "in the long run, this will be beneficial for the human race."

UTI vaccines now

Since the use of the vaccine Uromune, it has shown incredible results. Currently being used in the UK, studies have shown increased protection in patients who suffer from rUTIs. As of July 2023, the Uromune vaccine is still not available in the U.S. 

The most recent clinical trial of Uromune was held by Dr. J. Curtis Nickel of Queen's University in September of 2019, officially ending in January of 2023. The trial was conducted in Canada with 62 women over a 3-month treatment period. Findings have yet to be revealed.