title: Redefining Healthy Urine: A Cross-Sectional Exploratory Metagenomic Study of People With and Without Bladder Dysfunction.
abstract: OBJECTIVE
  We used the PathoScope platform to perform species level analyses of publicly available, 16S rRNA pyrosequenced, asymptomatic urine data to determine relationships between microbiomes, and clinical and functional phenotypes.
  
  
  METHODS
  We reanalyzed previously reported, cross-sectionally acquired urine samples from 47 asymptomatic subjects, including 23 controls and 24 subjects with neuropathic bladder. Urine was originally collected by the usual method of bladder drainage and analyzed by urinalysis, culture and pyrosequencing. Urinalysis and culture values were stratified as leukocyte esterase (0, or 1 or greater), nitrite (positive or negative), pyuria (fewer than 5, or 5 or greater white blood cells per high power field), cloudy urine (positive or negative) and urine culture bacterial growth (less than 50,000, or 50,000 or greater cfu/ml). PathoScope was used for next generation sequencing alignment, bacterial classification and microbial diversity characterization.
  
  
  RESULTS
  Subjects with neuropathic bladder were significantly more likely to have positive leukocyte esterase and pyuria, cloudy urine and bacterial growth. Of 47 samples 23 showed bacterial growth on culture and in all samples bacteria were identified by pyrosequencing. Nonneuropathic bladder urine microbiomes included greater proportions of Lactobacillus crispatus in females and Staphylococcus haemolyticus in males. The Lactobacillus community differed significantly among females depending on bladder function. Irrespective of gender the subjects with neuropathic bladder had greater proportions of Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumonia. In 4 subjects with neuropathic bladder Actinobaculum sp. was detected by sequencing and by PathoScope but not by cultivation and in all cases it was associated with pyuria.
  
  
  CONCLUSIONS
  Using PathoScope plus 16S pyrosequencing we were able to identify unique, phenotype dependent, species level microbes. Novel findings included absent L. crispatus in the urine of females with neuropathic bladder and the presence of Actinobaculum only in subjects with neuropathic bladder.
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, D.C.; Department of Rehabilitation Medicine, Georgetown University Hospital, Washington, D.C.. Electronic address: Suzanne.L.Groah@Medstar.net.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Groah
authors.affiliation: Department of Integrative Systems Biology, Children's National Health System, Washington, D.C.; Computational Biology Institute, George Washington University, Ashburn, Virginia; CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal.
authors.forename: Marcos
authors.initials: M
authors.lastname: Pérez-Losada
authors.affiliation: Department of Integrative Systems Biology, Children's National Health System, Washington, D.C.
authors.forename: Ljubica
authors.initials: L
authors.lastname: Caldovic
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, D.C.
authors.forename: Inger H
authors.initials: IH
authors.lastname: Ljungberg
authors.affiliation: Division of Urology, Children's National Health System, Washington, D.C.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Sprague
authors.affiliation: Computational Biology Institute, George Washington University, Ashburn, Virginia; Center for Bioinformatics and Integrative Biology, Facultad de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castro-Nallar
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, D.C.
authors.forename: Neel J
authors.initials: NJ
authors.lastname: Chandel
authors.affiliation: Division of Urology, Children's National Health System, Washington, D.C.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hsieh
authors.affiliation: Division of Urology, Children's National Health System, Washington, D.C.
authors.forename: Hans G
authors.initials: HG
authors.lastname: Pohl
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D056186:Metagenomics; D064307:Microbiota; D008875:Middle Aged; D010641:Phenotype; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000652:urine; D014556:Urine / Q000382:microbiology*
chemical_list: D015415:Biomarkers
keywords: metagenomics; microbiota; spinal cord injuries; urinary bladder, neurogenic; urine