Fig. 1

Antibiotic-sparing mannoside simultaneously treats an active bladder infection and targets the gastrointestinal reservoir of uropathogenic E. coli. Uropathogenic E. coli (UPEC) binds mannosylated proteins (blue) found on the epithelia of the gut and bladder. 1 In the gut, UPEC bind within the colonic crypts via interactions between the FimH adhesin on type I pili and mannose. 2 Mannosides (red) bind FimH with greater affinity than mannose, removing colonizing UPEC from the gastrointestinal tract. 3–5 The infection cycle of a urinary tract infection involves multiple stages, including initial attachment (3), intracellular proliferation (4), filamentation and efflux (5), and re-entry. Attachment and re-entry require FimH to bind mannose (blue) on the bladder epithelium. 6 Mannosides (red) bind FimH and prevent binding to bladder cells, promoting elimination of UPEC from the tissue. UPEC, Uropathogenic Escherichia coli