Putative effects of sexual hormones and cytokines in pre and post-menopausal women during bacterial urinary tract infection.

Urinary Tract Infections (UTI) affect mostly females. The infection and possible consequent ascent of bacteria is enhanced by various risk factors. Sex hormones regulate gene transcription implicated in immune cell development and maturation, in regulation of immune responses and immune signaling pathways. This study was designed to determine the relationship between UTI and some sex hormones and role of them in cytokines related to immune response in pre and post-menopausal women during bacterial infection. The study included 90 urine samples from females age (18-69) years: forty five were pre-menopause group subdivided into two groups includes (25 infected with UTI and 20 control subjects) , while others forty five post- menopause group includes (25 infected with UTI and 20 control subjects) were attending to clinic of urology at Salahaldeen hospital and private medical clinic in Tikrit City. Blood samples were collected from these women to determine the concentrations of sex hormones (Estrogen (E2), Progesterone)and cytokines includes (Interleukin10 (IL-10),Transforming Growth Factor-β (TGF-β), Human β-Defensin 2 (HBD2) and Toll-Like Receptor4 (TLR-4) in those Sera, they assaying using ELISA technique assay . The positive isolates were selected for infected females of pre and post-menopausal. Fifty bacterial isolated were isolated from infected women with UTI, and the most frequently isolated microorganisms 27(54%) were Gram-negative bacteria; 15(60%) and 12(48%) pre and post-menopausal respectively, Followed by Gram-positive bacteria 23(46%) isolated; 10(40%) and 13(52%) pre and post-menopausal respectively. According to current research results of urine culture bacterial isolation, the most commonly isolated microorganisms were: Escherichia coli 15(30%) 8(32%), 7(28%) pre and post-menopausal respectively; and Enterobacter fecales in 10(20%) 5(20%), 5(20%) pre and post-menopausal respectively. The most effective antimicrobial agents were Amikacin, Gentamicin and Amoxicillin but the less effective were Ceftriaxone, Norfloxacin, and Nitrofurantoin. The results showed that the concentration of estrogen and progesterone hormones were higher in pre and post-menopausal without UTI (414.0 ± 34.2 pg/ml; 1.589 ± 0.460) pg/ml (406.1 ± 30.71 pg/ml; 1.894 ± 0.292) while decreased in pre and post-menopausal with UTI respectively; and decreased in the levels of IL-10, TGF-β, HBD2 and TLR-4 in a females with UTI pre and post-menopausal when compared without UTI females. The interaction between sex hormones and the incidence, progression and morbidity of UTI may be due to effective role of them at the levels of some cytokines like of IL-10, TGF-β, HBD2 and TLR-4. The ability of sex hormones to increase production of antimicrobial peptides, combined with the effect on epithelial integrity or distribution of proteins associated with cell-cell contact, to mention a few, place them as possible candidates for supportive treatment of UTI.