Antibacterial activity of pentosan polysulfate sodium against uropathogenic bacteria

BACKGROUND: The primary causative agents of lower urinary tract infections are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. In recent years, these bacteria have demonstrated high levels of antibiotic resistance. The barrier function of the bladder mucosal epithelium is largely determined by the glycosaminoglycan layer, which protects the bladder wall from infectious agents. Disruption of this layer leads to inflammation, which may progress to painful bladder syndrome or cystitis. Pentosan polysulfate sodium is a semisynthetic glycosaminoglycan that is chemically and structurally similar to naturally occurring glycosaminoglycans. It restores the damaged urothelial layer and prevents contact between the bladder mucosal epithelium and various aggressive substances dissolved in urine. AIM: This work aimed to investigate the in vitro antibacterial, antiadhesive, and antibiofilm activities of pentosan polysulfate sodium. METHODS: Classical bacteriological methods, mass spectrometry, microscopy, an experimental adhesion model using buccal epithelial cells, and statistical data analysis were used. Study material was obtained from women aged 18 years and older with a history of cystitis lasting at least three years during disease exacerbation. RESULTS: The antibacterial effect of pentosan polysulfate sodium during co-cultivation with the main pathogens of lower urinary tract infections persisted for up to 15 hours. The mechanism of antibacterial action was associated with the ability of pentosan polysulfate sodium to inhibit bacterial adhesion to the urothelium. The most pronounced antiadhesive effect was observed against E. faecalis: in the presence of pentosan polysulfate sodium, there was a 3.7-fold decrease in the number of bacteria adhered to buccal epithelial cells. The adhesion index decreased by 3.3-fold for E. coli and 2.6-fold for K. pneumoniae. Pentosan polysulfate sodium also demonstrated antibiofilm properties, reducing the density of biofilms formed by E. coli by 1.7-fold, E. faecalis by 1.6-fold, and K. pneumoniae by 1.2-fold. These findings confirm the potential of pentosan polysulfate sodium to enhance the effectiveness of therapy for lower urinary tract infections, particularly those associated with microbial biofilms. CONCLUSION: This in vitro study made it possible to identify and quantitatively assess the antibacterial, antiadhesive, and antibiofilm activities of pentosan polysulfate sodium against uropathogenic microorganisms isolated from the urine of patients with recurrent lower urinary tract infections.