Perfusable 3D human urothelial model for real-time analysis of bacterial infection dynamics and therapeutic interventions

Urinary tract infections (UTIs) remain a major health burden, yet mechanistic studies are limited by the lack of experimental models that enable high spatiotemporal resolution tracking of infection dynamics, while recapitulating the stratified architecture of the bladder epithelium, urine tolerance and fluid dynamics. Here, we present a modular microphysiological platform integrating a fully stratified, urine-tolerant human urothelium cultured on standard transwell inserts within a custom-designed perfusion device compatible with live imaging. Urine flow enables real-time, high-resolution imaging of uropathogenic Escherichia coli (UPEC) infections under physiologically relevant conditions, including clearance of planktonic bacteria and nutrients replenishment, while retaining tissue-associated populations. This system revealed UPEC attachment via the type 1 fimbrial adhesin FimH and its inhibition by D-mannose treatment. Moreover, the platform captured L-form formation upon treatment with the frontline antibiotic fosfomycin and regrowth of walled bacteria following drug withdrawal. The platform further uncovered strain-specific lysis through bacteriophages in contrast to the activity of broad-spectrum antibiotics. In summary, this system constitutes a scalable platform with high predictive power for studying UTI pathogenesis and preclinical therapeutic testing.