Objective: The study aims to investigate interleukin -1 beta (IL-1\(\beta\)) in patients with urinary tract infections in the holy governorate of Karbala. Methods: This study was conducted during the period from October 2023 to February 2024 at Imam Hussein Hospital in the holy city of Karbala and the laboratories of the College of Applied Medical Sciences/University of Kerbala.
The current study included collecting urine samples (for use in general urine examination) and blood (using blood directly to measure the complete blood count CBC and serum to measure interleukin -1 beta (IL-1\(\beta\)) from 70 patients with urinary tract infection (35 patients with positive bacterial growth and 35 patients with negative bacterial growth) in addition to 70 healthy people. The following general criteria were also investigated: age, sex, height, and weight. Results: Eight bacterial species were obtained. From the findings of the study is the increase in concentration of IL-1\(\beta\) in patients with urinary tract infections compared to the control group. The presence of a negative correlation between LBP and IL-1\(\beta\). Conclusions: Increase the concentration of IL-1\(\beta\) in patients with urinary tract infections. There is a negative correlation in patients with bacterial growth between LBP and IL-1\(\beta\).
Urinary tract infection (UTI), in humans, inflammation of the renal system characterized by frequent and painful urination and caused by the invasion of microorganisms, usually bacteria, into the urethra and bladder. Infection of the urinary tract can result in either minor or major illness [1].
UTIs is a common clinical problem that comprises 1–6% of medical referrals and includes urinary tract, bladder, and kidney infections [2]. Urinary tract infections (UTIs) represent the most common bacterial illnesses that occur in various settings, including community and clinical environments. Bacteria are the primary etiological agents of these infections, however less frequently, other species, such as fungi and some viruses, have been documented as the causal agents of UTIs [3].
UTIs are accompanied by inflammation, which involves several cytokines such as TNF-\(\alpha\), interleukin (IL)-1\(\beta\), IL-6, and IL-8 [4]. The origins of interleukin-1 (IL-1) can be traced back to the 1940s when researchers first identified the fever-inducing properties of "soluble factors" produced by leukocytes stimulated by endotoxins. Since then, the field of IL-1 has expanded to include the discovery of inflammasomes, the clinical advantages of anti-IL-1\(\beta\) therapy, and the study of inflammatory cytokines, Toll-like receptors (TLRs), and innate immune responses [5]. IL-1 consists of two agonists, IL-1\(\alpha\) and IL-1\(\beta\), that initiate signals by binding to IL-1 receptor 1 (IL-1R1) and enlisting an additional peptide chain for assistance [6].
Despite the relatively low homology (27%) in terms of amino acid sequences, IL-1\(\alpha\) and IL-1\(\beta\) exhibit structural similarities and perform similar functions. They both interact with the IL-1 type 1 receptor (IL-1R1) and possess a core \(\beta\)-barrel structure with adjacent loops [7].The reason for having two IL-1 agonists may lie in the difference in robustness or specific functions between them [8].
Interleukin-1 beta (IL-1\(\beta\)) is a pro-inflammatory cytokine, meaning it plays a role in promoting inflammation as part of the immune response. It is produced by various cells, including immune cells (such as macrophages and monocytes) and non-immune cells (such as epithelial cells). IL-1\(\beta\) is one of the most potent pro-inflammatory cytokines and it has been linked to dysregulated inflammation and to the severity of the UTI [9].
IL-1\(\beta\) is induced by inflammatory signals in a broad number of immune cell types [10]. Monocytes and macrophages are the main sources of IL-1\(\beta\) secretion. It causes harm to the tissue and the entry of neutrophils into it. In order to prevent unregulated inflammation, the release of the active form of IL-1\(\beta\) is carefully controlled and influenced by a molecular complex known as the inflammasome [4]. IL-1\(\beta\) is synthesized as a 269-amino acid precursor protein and undergoes processing by caspase-1, also known as IL-1\(\beta\)-converting enzyme (ICE), which is activated in inflammasomes. This processing results in the production of mature IL-1\(\beta\), consisting of the C-terminal 153 amino acids [11]. During the interaction between the host cell and the pathogen, there is a sudden release of cytokines. This release is aimed at attracting the cells of the innate immune system and strengthening the body’s defense against pathogens. Cytokines in urinary tract infections (UTIs) are mostly generated within the uroepithelial cell lining of the bladder and released into the urine [12].
IL-1\(\beta\) shows potential as a useful indicator for distinguishing between upper and lower urinary tract infections (UTIs) [13]. Interleukin-1 beta (IL-1\(\beta\)), a substance commonly seen in the blood of children with urinary tract infections (UTIs), has been utilized as an indicator for acute pyelonephritis [14].
Collection of the samples: A positive urinary tract infection (UTI) was diagnosed in patients following a general urine examination (G.U.E.) and control.
Collecting the Blood Sample: Each participant provided a 5 ml sample of venous blood using a disposable syringe. The serum samples were concentrated using a centrifuge at an approximate speed of 3000 revolutions per minute (rpm) for a duration of 10 minutes. The serum was carefully transferred into two eppendorf tubes and stored at -20°C to prevent any potential damage from repeated freezing-thawing cycles. This preserved the serum for further measurement of Lipopolysaccharide Binding Protein.
A. Preparation of Culture Media
Blood Agar: A suspension of 40 g of blood agar was made in 1Lof distilled water (DW). The mixture was heated until it completely dissolved. Next, the sterilization process involves subjecting the material to a temperature of 121°C for a duration of 15 minutes. The agar was cooled to a temperature of 45 - 50°C and then 7% of sterilized defibrinated blood was added. The media was utilized for culturing and activating bacteria that had been collected from various samples. The bacteria that was collected from samples was activated [15].
MacConkey Agar: MacConkey Agar is a type of agar used in laboratory settings. It is commonly used to differentiate between different types of bacteria based on their ability to ferment lactose. The agar contains specific indicators that change color depending on whether lactose fermentation has occurred. This allows researchers to analyze and identify different bacterial species. To prepare this medium, dissolve 40gm of agar in 1000 ml of D.W and sterilize it in an autoclave at 121C° for 20 minutes. Once cooled, the mixture was carefully poured onto the plates. These plates were specifically designed to selectively culture gram-negative bacteria [16].
Muller Hinton Agar: The steps of weighing 38 g of media, dissolving it in 1L of D.W, and autoclaving it for 15 minutes was carried out in accordance with the instructions provided by the company [17].
Identification through the use of automated methods The VITEK2 system: Automated methods are highly efficient and accurate when it comes to identifying bacteria. The VITEK2 system is composed of plastic reagent cards that contain small amounts of various biochemical test media in 30 wells. These wells provide a biochemical profile that is used to diagnose organisms. The inoculum is transferred from cultured samples into the card, and a photometer periodically measures the color changes in the card resulting from the microbe’s metabolic activity. The data was thoroughly analyzed and efficiently stored in a computerized database. A variety of cards, such as those for Gram-negative identification (GN) and Gram-positive identification (GP), are available. The work of [18].
B. Estimation the level of IL-1\(\beta\)
Principle: The test principle utilized in this kit is the Sandwich enzyme immunoassay. The microtiter plate included in this kit comes pre-coated with an antibody that targets Interleukin 1 Beta (IL-1\(\beta\)). Standards or samples are added to the appropriate microtiter plate wells, followed by the addition of a biotin-conjugated antibody that specifically targets IL-1\(\beta\).Then, Avidin conjugated to Horseradish Peroxidase (HRP) is added to each microplate well and incubated, just like a scientist carefully conducting an experiment. When the TMB substrate solution is added, the wells that have IL-1\(\beta\), biotin-conjugated antibody, and enzyme-conjugated Avidin will be the ones that show a color change. Termination of the enzyme-substrate reaction involves the addition of a sulphuric acid solution, followed by the measurement of the resulting color change using spectrophotometry at an approximately 450 nm ± 10 nm in wavelength. The concentration of IL-1\(\beta\) in the samples is determined by comparing the OD of the samples to the standard curve.
KIT Components and Storage : The components and storage information for the IL-1\(\beta\) ELISA Kit were provided in Table 1.
Reagents | Quantity | Storage Condition | |
---|---|---|---|
48 T | 96 T | ||
Pre-Coated Microplate | 6 strips x 8 wells | 12 strips x 8 wells | -20ºC (6 months) |
Standard (Lyophilized) | 1 vial | 2 vials | -20°C (6 months) |
Biotinylated Antibody (100X) | 60 \(\mu\)L | 120 \(\mu\)L | -20°C (6 months) |
Streptavidin-HRP (100X) | 60 \(\mu\)L | 120 \(\mu\)L | -20°C (6 months) |
Standard/Sample Diluent Buffer | 10 mL | 20 mL | 4°C |
Biotinylated Antibody Diluent | 6 mL | 12 mL | 4°C |
HRP Diluent | 6 mL | 12 mL | 4°C |
Wash Buffer (25X) | 10 mL | 20 mL | 4°C |
TMB Substrate Solution | 6 mL | 10 mL | 4°C(store in dark) |
Stop Reagent | 3 mL | 6 mL | 4°C |
Plate Covers | 1 Piece | 2 Pieces | 4°C |
C. Preparing the reagents
D. Preparing Samples
E. Procedure for conducting the assay
The results in Table 2 showed that there was a highly significant increase (P < 0.05) in the concentration of IL-1\(\beta\) (pg/ml) in two groups of patients compared with control group.
Groups | Mean ± SE | P value | LSD | |
---|---|---|---|---|
Case | Bacterial Growth | 165.66 ± 10.31 | 0.0000 ** | 31.145 |
No Bacterial Growth | 229.79 ± 10.94 | |||
Control | 127.24 ± 5.54 | |||
NS: Non significant P value * : Significant P value ** : Highly Significant P value |
The results showed that there was a highly significant increase (P < 0.05) in the concentration of IL-1\(\beta\) (pg/ml) in tow patient groups (female and male) compared to control group. We find that the concentration of IL-1\(\beta\) increases significantly (P<0.05) in the tow patient groups compared to the control group in all groups. Based on the BMI criterion, a significant increase (P<0.05) was observed in the concentration of IL-1\(\beta\) for all BMI categories, whether Normal, Overweight, or Obese, in tow patient groups compared to Control, as show in the Table 3.
Criteria | Class | N | Mean ± SE of IL-1\(\beta\) in studied Groups | P value | LSD | ||
Control (70) | Patients Growth(35) | Patients No Growth(35) | |||||
Sex | Female (N) |
112 | 132.7±6.12 (56) |
164.2±12.07 (28) |
231.2±13.20 (28) |
0.0000* | 27.53 |
Male (N) |
28 | 136.1±9.96 (14) |
171.9±18.63 (7) |
212.8±24.83 (7) |
0.0076* | 52.78 | |
P value | 0.00001* | 0.7981 | 0.7689 | 0.5333 | |||
Age (years) | 18 – 37 (N) |
62 | 130.53±8.15 (31) |
188.2±14.87 (16) |
234.9±12.23 (15) |
0.0000* | 32.736 |
38 – 57 (N) |
52 | 141.18±8.80 (26) |
144.9±15.02 (14) |
205.8±22.02 (12) |
0.0053* | 15.769 | |
58 – 77 (N) |
26 | 92.32±9.73 (13) |
164.1±29.82 (5) |
263.3±20.04 (8) |
0.0000* | 46.792 | |
P value LSD |
0.00091* | 0.0056* 14.628 |
0.1506 NS |
0.1278 NS |
|||
BMI (kg/m2) | Normal 25 |
28 | 135.8±11.59 (14) |
160.7±23.90 (3) |
207.9±16.22 (11) |
0.0037* | 50.11 |
Overweight 25 – 29.9 |
88 | 147.7±5.96 (44) |
165.8±11.40 (29) |
239.7±11.87 (15) |
0.0000* | 21.89 | |
Obese \(\geq\) 30 |
24 | 94.7±10.21 (12) |
170.7±46.70 (3) |
235.9±32.23 (9) |
0.0006* | 83.07 | |
P value LSD |
0.00001* | 0.0006* 15.63 |
0.9805 NS |
0.4391 NS |
The results was approved that there was non-significant difference in IL-1\(\beta\) concentration according to the types of bacterial isolates as show in Table 4.
Type of bacteria | N | Mean | SE | P value | LSD |
---|---|---|---|---|---|
E. coli | 13 | 173.2 | 15.03 | 0.5193 | NS |
Enterococcus faecalis | 1 | 268.0 | 0.0 | ||
Enterococcus faecium | 1 | 203.6 | 0.0 | ||
Klebsiella aerogenes | 3 | 151.9 | 27.42 | ||
Klebsiella pneumoniae ssp | 2 | 99.2 | 12.44 | ||
Staphylococcus aureus | 4 | 168.8 | 42.2 | ||
Staphylococcus haemolyticus | 3 | 145.7 | 25.46 | ||
Staphylococcus saprophyticus | 8 | 167.2 | 25.80 |
The results of current study not similar with results of Alfadul et al. founded there is a relationship between diabetes and elevation of levels of IL-1\(\beta\) [19]. IL-1\(\beta\) could be a promising marker for differentiation between upper and lower UTIs [20]. Butler et al. who suggested IL-1\(\beta\) release to be important for the progression of urinary tract infection (UTI) [21]. The current study agreed with a study of [22]. which showed highly significant relationship between the level of IL-1\(\beta\) (pg/ml) in patient group and would not agree highly significant relationship between the level of IL-1\(\beta\) (pg/ml) and bacterial infections (P < 0.01). Inversely , found that IL-1b level were higher in patient with growth bacterial compared with no growth bacterial [23].
Maculewicz et al. [24] were observed relationship between BMI and IL-1\(\beta\), in patients with infection and BMI \(\geq\) 30 they have high significant , obesity is a major factor that leads to increase IL-1\(\beta\). The similar study reported by [25]. founding the level of IL-1\(\beta\) increase with age , when age \(\geq\) 18 observed highly significant (P<0.05) in IL-1\(\beta\).
The results of current study disagreement with [26] they founded that the release of IL- 1\(\beta\) was linked with E. coli infections.
The authors declare no conflict of interests. All authors read and approved final version of the paper.
All authors contributed equally in this paper.