Diabetes Mellitus Affects Urinary Tissue Tropism of Group B Streptococci in a Sex-Dependent Manner

Abstract Diabetes mellitus (DM) increases susceptibility to Streptococcus agalactiae (group B Streptococcus or GBS) urinary tract infections (UTI) and their exacerbations such as ascending pyelonephritis and sepsis, although underlying molecular mechanisms have not been fully deciphered. To address our hypothesis that DM mediated alterations in the host urinary immune defenses increase susceptibility to GBS-UTI, we inoculated, via transurethral route, GBS strain 10/84 into the urinary bladders of 8 weeks old, male and female, diabetic (obese, hyperglycemic mice denoted as D) and non-diabetic (ND) mouse littermates. At 24 h post-infection (hpi), compared to their ND littermates, the D-mice showed significantly higher GBS CFUs in the bladder, the kidneys, and the spleen. This was accompanied by a significantly reduced recruitment of CD45 + leukocytes to and suppression of pro-inflammatory cytokine production in GBS-infected D-bladder and D-kidneys compared to their ND counterparts. We also noted sex-dependent differences in GBS urinary tissue tropism. For example, D-females exhibited significantly higher bladder burden compared to ND-females, D-males, and to ND-males, while the bladder burden in ND-females was not significantly different from that in ND-males. In contrast, ND-males showed significantly higher kidney CFUs than ND-females and DM further increased kidney CFU burden in males. GBS-induced recruitment of CD45 + leukocytes was not different between male and female mice within either D or ND cohorts. GBS-UTI induced significantly higher CXCL1 production in male bladders in both D and ND cohorts compared to their female counterparts. These results indicate that DM increases susceptibility to GBS-UTI and the dissemination to spleen by affecting leukocyte recruitment and pro-inflammatory cytokine production in a sex-dependent manner. Importance In this study we sought to understand why diabetic individuals are more susceptible to urinary tract infections (UTI) by Gram positive Streptococcus agalactiae (group B Streptococcus or GBS). We induced UTI by inoculating GBS into the bladders of diabetic (obese, hyperglycemic) and non-diabetic, male and female mice. At 24 hours after infection, compared to the non-diabetic mice, the diabetic mouse urinary tracts showed higher GBS counts and reduced immune defenses. Diabetes also promoted dissemination of GBS to the spleen. Furthermore, female diabetic mice were more susceptible to bladder infection while diabetes worsened the increased overall susceptibility of males to kidney infection, a difficult-to-treat, potentially life threatening exacerbation of GBS-UTI. Overall, our results suggest that both diabetes and sex are important determinants of susceptibility to GBS-UTI and resulting severe outcomes.