title: Cranberry-derived proanthocyanidins prevent formation of Candida albicans biofilms in artificial urine through biofilm- and adherence-specific mechanisms.
abstract: OBJECTIVE
  Candida albicans is a common cause of nosocomial urinary tract infections (UTIs) and is responsible for increased morbidity and healthcare costs. Moreover, the US Centers for Medicare & Medicaid Services no longer reimburse for hospital-acquired catheter-associated UTIs. Thus, development of specific approaches for the prevention of Candida urinary infections is needed. Cranberry juice-derived proanthocyanidins (PACs) have efficacy in the prevention of bacterial UTIs, partially due to anti-adherence properties, but there are limited data on their use for the prevention and/or treatment of Candida UTIs. Therefore, we sought to systematically assess the in vitro effect of cranberry-derived PACs on C. albicans biofilm formation in artificial urine.
  
  
  METHODS
  C. albicans biofilms in artificial urine were coincubated with cranberry PACs at serially increasing concentrations and biofilm metabolic activity was assessed using the XTT assay in static microplate and silicone disc models.
  
  
  RESULTS
  Cranberry PAC concentrations of ≥16 mg/L significantly reduced biofilm formation in all C. albicans strains tested, with a paradoxical effect observed at high concentrations in two clinical isolates. Further, cranberry PACs were additive in combination with traditional antifungals. Cranberry PACs reduced C. albicans adherence to both polystyrene and silicone. Supplementation of the medium with iron reduced the efficacy of cranberry PACs against biofilms.
  
  
  CONCLUSIONS
  These findings indicate that cranberry PACs have excellent in vitro activity against C. albicans biofilm formation in artificial urine. We present preliminary evidence that cranberry PAC activity against C. albicans biofilm formation is due to anti-adherence properties and/or iron chelation.
authors.affiliation: Section of Infectious Diseases, New Mexico Veterans Healthcare System, Albuquerque, NM, USA.
authors.forename: Hallie S
authors.initials: HS
authors.lastname: Rane
authors.forename: Stella M
authors.initials: SM
authors.lastname: Bernardo
authors.forename: Amy B
authors.initials: AB
authors.lastname: Howell
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Lee
mesh_terms: D000935:Antifungal Agents / Q000302:isolation & purification / Q000494:pharmacology*; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development; D002176:Candida albicans / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D010936:Plant Extracts / Q000302:isolation & purification / Q000494:pharmacology; D044945:Proanthocyanidins / Q000302:isolation & purification / Q000494:pharmacology*; D014556:Urine / Q000382:microbiology; D029799:Vaccinium macrocarpon
chemical_list: D000935:Antifungal Agents; D010936:Plant Extracts; D044945:Proanthocyanidins
keywords: Vaccinium macrocarpon Ait.; cranberry PACs; urinary catheters; urinary tract infections