Internal medicine

Urinary system

Biology

Microbiology

Chemokine

Innate immune system

Acquired immune system

Immunology

Inflammation

Immunity

Urothelium

Antimicrobial peptides

Antimicrobial

Medicine

Immune system

Nature Reviews Urology

The bladder is continuously protected by passive defences such as a mucus layer, antimicrobial peptides and secretory immunoglobulins; however, these defences are occasionally overcome by invading bacteria that can induce a strong host inflammatory response in the bladder. The urothelium and resident immune cells produce additional defence molecules, cytokines and chemokines, which recruit inflammatory cells to the infected tissue. Resident and recruited immune cells act together to eradicate bacteria from the bladder and to develop lasting immune memory against infection. However, urinary tract infection (UTI) is commonly recurrent, suggesting that the induction of a memory response in the bladder is inadequate to prevent reinfection. Additionally, infection seems to induce long-lasting changes in the urothelium, which can render the tissue more susceptible to future infection. The innate immune response is well-studied in the field of UTI, but considerably less is known about how adaptive immunity develops and how repair mechanisms restore bladder homeostasis following infection. Furthermore, data demonstrate that sex-based differences in immunity affect resolution and infection can lead to tissue remodelling in the bladder following resolution of UTI. To combat the rise in antimicrobial resistance, innovative therapeutic approaches to bladder infection are currently in development. Improving our understanding of how the bladder responds to infection will support the development of improved treatments for UTI, particularly for those at risk of recurrent infection. Lacerda Mariano and Ingersoll discuss how bacterial urinary tract infection affects the bladder, focusing on the development of immune responses and the cells and pathways that mediate immunity. They also highlight therapeutic approaches to bladder infection that are currently under development.

The immune response to infection in the bladder