Cathelicidin: A Natural Antimicrobial Peptide With Diagnostic and Therapeutic Potential in Urinary Tract Diseases

Cathelicidin is rapidly produced by uroepithelial cells upon pathogen contact, making it a potential early UTI biomarker. Post-UTI cathelicidin levels lower than healthy controls suggest a risk factor for recurrence. Cathelicidin also shows promise as a biomarker for severe vesicoureteral reflux and renal scarring. Multiple therapeutic agents that upregulate cathelicidin expression are under investigation.

Comprehensive review searching Scopus, Medline, and Web of Science databases for all published studies on cathelicidin in urinary tract diseases, covering diagnostic, prognostic, and therapeutic applications.

With antibiotic resistance rising, leveraging the body's own antimicrobial defenses is increasingly important. Cathelicidin-based diagnostics could enable faster UTI detection than traditional culture methods, while cathelicidin-boosting therapies could reduce antibiotic dependence. Identifying patients with low cathelicidin levels could also enable preventive strategies for those prone to recurrent UTIs.

Antimicrobial peptides represent the evolutionary frontline of immune defense, predating antibiotics by hundreds of millions of years. Understanding and enhancing these natural defenses is a major strategy for combating antibiotic resistance. Cathelicidin's role in the urinary tract is just one example of how innate immune peptides could transform infectious disease management.

Review format inherently depends on the quality and quantity of available studies, which varies considerably across the different clinical applications discussed. Most cathelicidin biomarker studies have been relatively small. Therapeutic cathelicidin upregulation is still in early stages with limited clinical data. Standardization of cathelicidin measurement methods across studies remains a challenge.