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Kawahara R, Fujii T, Kukimoto I, Nomura H, Kawasaki R, Nishio E, Ichikawa R, Tsukamoto T, Iwata A. Changes to the cervicovaginal microbiota and cervical cytokine profile following surgery for cervical intraepithelial neoplasia. Sci Rep 2021; 11:2156. [PMID: 33495564 PMCID: PMC7835242 DOI: 10.1038/s41598-020-80176-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/15/2020] [Indexed: 01/04/2023] Open
Abstract
Persistent HPV infection associated with immune modulation may result in high-grade squamous intraepithelial lesions (CIN)2/3. Currently, there is little information on the cervicovaginal microbiome, local cytokine levels and HPV infection related to CIN. Follow-up of patients after local surgery provides an opportunity to monitor changes in the cervicovaginal environment. Accordingly, we undertook this longitudinal retrospective study to determine associations between HPV genotypes, cervicovaginal microbiome and local cytokine profiles in 41 Japanese patients with CIN. Cervicovaginal microbiota were identified using universal 16S rRNA gene (rDNA) bacterial primers for the V3/4 region by PCR of genomic DNA, followed by MiSeq sequencing. We found that Atopobium vaginae was significantly decreased (p < 0.047), whereas A. ureaplasma (p < 0.022) increased after surgery. Cytokine levels in cervical mucus were measured by multiplexed bead-based immunoassays, revealing that IL-1β (p < 0.006), TNF-α (p < 0.004), MIP-1α (p < 0.045) and eotaxin (p < 0.003) were significantly decreased after surgery. Notably, the level of eotaxin decreased in parallel with HPV clearance after surgery (p < 0.028). Thus, local surgery affected the cervicovaginal microbiome, status of HPV infection and immune response. Changes to the cervicovaginal microbiota and cervical cytokine profile following surgery for cervical intraepithelial neoplasia may be important for understanding the pathogenesis of CIN in future.
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Affiliation(s)
- Rina Kawahara
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan.
| | - Iwao Kukimoto
- Pathogen Genomics Center, National Institute of Infectious Diseases, 4-7-1, Gakuen, Musashi-murayama, Tokyo, 208-0011, Japan
| | - Hiroyuki Nomura
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Rie Kawasaki
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Eiji Nishio
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Ryoko Ichikawa
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsukamoto
- Department of Pathology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
| | - Aya Iwata
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Toyoake, Aichi, 470-1192, Japan
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152
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Kombe Kombe AJ, Li B, Zahid A, Mengist HM, Bounda GA, Zhou Y, Jin T. Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health 2021; 8:552028. [PMID: 33553082 PMCID: PMC7855977 DOI: 10.3389/fpubh.2020.552028] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.
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Affiliation(s)
- Arnaud John Kombe Kombe
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Gabonese Scientific Research Consortium, Libreville, Gabon
| | - Bofeng Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ayesha Zahid
- Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hylemariam Mihiretie Mengist
- Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Guy-Armel Bounda
- Gabonese Scientific Research Consortium, Libreville, Gabon.,Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Sinomedica Co., Ltd., Mong Kok, Hong Kong
| | - Ying Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tengchuan Jin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Chinese Academy of Science Center for Excellence in Molecular Cell Science, Shanghai, China
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153
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Carrillo-Ng H, Becerra-Goicochea L, Tarazona-Castro Y, Pinillos-Vilca L, Del Valle LJ, Aguilar-Luis MA, Tinco-Valdez C, Silva-Caso W, Martins-Luna J, Peña-Tuesta I, Aquino-Ortega R, Del Valle-Mendoza J. Variations in cervico-vaginal microbiota among HPV-positive and HPV-negative asymptomatic women in Peru. BMC Res Notes 2021; 14:4. [PMID: 33407849 PMCID: PMC7788800 DOI: 10.1186/s13104-020-05422-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus. Results A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%).
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Affiliation(s)
- Hugo Carrillo-Ng
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | | | - Yordi Tarazona-Castro
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.,Escuela Profesional de Genética y Biotecnología, Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Luis J Del Valle
- Departament d'Enginyeria Química, EEBE, Barcelona Research Center for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Carmen Tinco-Valdez
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Wilmer Silva-Caso
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
| | - Johanna Martins-Luna
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Isaac Peña-Tuesta
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Ronald Aquino-Ortega
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Juana Del Valle-Mendoza
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos Cuadra 2, Chorrillos, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
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154
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Wong-Rolle A, Wei HK, Zhao C, Jin C. Unexpected guests in the tumor microenvironment: microbiome in cancer. Protein Cell 2020; 12:426-435. [PMID: 33296049 PMCID: PMC8106554 DOI: 10.1007/s13238-020-00813-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022] Open
Abstract
Although intestinal microbiome have been established as an important biomarker and regulator of cancer development and therapeutic response, less is known about the role of microbiome at other body sites in cancer. Emerging evidence has revealed that the local microbiota make up an important part of the tumor microenvironment across many types of cancer, especially in cancers arising from mucosal sites, including the lung, skin and gastrointestinal tract. The populations of bacteria that reside specifically within tumors have been found to be tumor-type specific, and mechanistic studies have demonstrated that tumor-associated microbiota may directly regulate cancer initiation, progression and responses to chemo- or immuno-therapies. This review aims to provide a comprehensive review of the important literature on the microbiota in the cancerous tissue, and their function and mechanism of action in cancer development and treatment.
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Affiliation(s)
- Abigail Wong-Rolle
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, 4 Memorial Drive, Bethesda, MD, 20892, USA
| | - Haohan Karen Wei
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, 421 Curie Blvd., Philadelphia, PA, 19104, USA
| | - Chen Zhao
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, 4 Memorial Drive, Bethesda, MD, 20892, USA.
| | - Chengcheng Jin
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, 421 Curie Blvd., Philadelphia, PA, 19104, USA.
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155
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Karpinets TV, Solley TN, Mikkelson MD, Dorta-Estremera S, Nookala SS, Medrano AYD, Petrosino JF, Mezzari MP, Zhang J, Futreal PA, Sastry KJ, Colbert LE, Klopp A. Effect of Antibiotics on Gut and Vaginal Microbiomes Associated with Cervical Cancer Development in Mice. Cancer Prev Res (Phila) 2020; 13:997-1006. [PMID: 32917644 PMCID: PMC10583130 DOI: 10.1158/1940-6207.capr-20-0103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
Antibiotics affect microbial diversity in the gut, leading to dysbiosis and impaired immunity. However, the impact of antibiotics on microbial communities at other sites, such as vagina is less understood. It is also not clear whether changes induced by antibiotics in both microbiomes affect the development of cervical cancer. In this study, we utilized the murine model to evaluate these questions. We show that oral application of broad-spectrum antibiotics in mice changed not only diversity, but composition and sharing of gut and vaginal microbiomes in mice and influenced cervical cancer development in an orthotopic tumor model. Antibiotics decreased richness and diversity indexes in the gut but increased them in the vagina. Some beneficial taxa, such as Bacteroides, Ruminococcaceae, and Lachnospiraceae increased their abundance in the vagina while other pathogenic species, such as Proteobacteria, were decreased. As a result of the changes, mice with greater richness and diversity of the vaginal microbiome after antibiotics exposure were less likely developed tumors. No association between richness and diversity of the gut microbiome and tumor development was identified.
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Affiliation(s)
| | - Travis N Solley
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Megan D Mikkelson
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Sita S Nookala
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Joseph F Petrosino
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas
| | - Melissa P Mezzari
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas
| | - Jinghua Zhang
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, Texas
| | - P Andrew Futreal
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, Texas
| | - K Jagannadha Sastry
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Lauren E Colbert
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
| | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
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156
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Castanheira CP, Sallas ML, Nunes RAL, Lorenzi NPC, Termini L. Microbiome and Cervical Cancer. Pathobiology 2020; 88:187-197. [PMID: 33227782 DOI: 10.1159/000511477] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022] Open
Abstract
Persistent infection with some types of mucosal human papillomavirus (HPV) is the etiological factor for the development of cervical cancer and its precursor lesions. Besides, several cofactors are known to play a role in cervical disease onset and progression either by favoring or by preventing HPV infection and persistence. The microbiome of a healthy female genital tract is characterized by the presence of 1 or few varieties of lactobacilli. However, high-throughput studies addressing the bacterial diversity and abundance in the female genital tract have shown that several factors, including hormonal levels, hygiene habits, and sexually transmitted diseases may disrupt the natural balance, favoring the outgrowth of some groups of bacteria, which in turn may favor some pathological states. Recently, the vaginal microbiome has emerged as a new variable that could greatly influence the natural history of HPV infections and their clinical impact. In this context, changes in the vaginal microbiome have been detected in women infected with HPV and women with HPV-associated lesions and cancer. However, the role of specific bacteria groups in the development/progression or prevention/regression of HPV-associated pathologies is not well understood. In this review we summarize the current knowledge concerning changes in vaginal microbiome and cervical disease. We discuss the potential functional interplay between specific bacterial groups and HPV infection outcomes.
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Affiliation(s)
| | - Mayara Luciana Sallas
- Innovation in Cancer Laboratory, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rafaella Almeida Lima Nunes
- Innovation in Cancer Laboratory, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Lara Termini
- Innovation in Cancer Laboratory, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,
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157
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Efficacy and safety of an adsorbent and anti-oxidative vaginal gel on CIN1 and 2, on high-risk HPV, and on p16/Ki-67: a randomized controlled trial. Arch Gynecol Obstet 2020; 303:501-511. [PMID: 33219482 PMCID: PMC7858556 DOI: 10.1007/s00404-020-05816-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The effect of SAM vaginal gel, a medical device containing adsorptive silicon dioxide and antioxidative sodium selenite and citric acid, on histologically-proven cervical intraepithelial neoplasia type 2 (CIN2) as well as p16 positive CIN1, and on the presence of the onco-marker p16 was investigated. METHODS 216 women aged 25-60 years were randomized to either receive an intravaginal daily dose of SAM gel for three 28-day periods, or be followed-up without intervention. The primary endpoint was efficacy, defined as a combined histological and cytological regression. At baseline and after 3 months participants had: a guided biopsy including p16 immunohistochemical (IHC) staining, only if a lesion was visible at colposcopy; a cervical smear for cytology, high-risk human papillomavirus (hr-HPV) and a p16/Ki-67 test. At 6 months a further cytology and p16/Ki-67 test was performed. RESULTS Regression of CIN lesions was observed in 78 out of 108 patients (72.2%) in the SAM gel arm and in 27 out of 108 patients (25.0%) in the control arm. Similarly, the change in the p16/Ki-67 cytological test status was significantly in favor of the treatment arm. The prevalence of hr-HPV decreased significantly (p < 0.001) in the treatment arm, from 87.0% to 39.8%, while it slightly increased in the control arm, from 78.7% to 83.3%. At 6 months the cytological regression in the treatment group and the highly significant effect on p16/Ki-67 was still present. CONCLUSION SAM vaginal gel enhances the regression of cervical lesions and clears hr-HPV and p16/Ki-67 in smears significantly, thus offering an active non-destructive management to prevent cervical cancer. TRIAL REGISTRATION NUMBER ISRCTN11009040, date of registration: 10/12/2019; https://doi.org/10.1186/ISRCTN11009040 ; retrospectively registered.
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158
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Assessment of In Vitro and In Silico Protocols for Sequence-Based Characterization of the Human Vaginal Microbiome. mSphere 2020; 5:5/6/e00448-20. [PMID: 33208514 PMCID: PMC7677004 DOI: 10.1128/msphere.00448-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The vaginal microbiome has been connected to a wide range of health outcomes. This has led to a thriving research environment but also to the use of conflicting methodologies to study its microbial composition. Here, we systematically assessed best practices for the sequencing-based characterization of the human vaginal microbiome. As far as 16S rRNA gene sequencing is concerned, the V1-V3 region performed best in silico, but limitations of current sequencing technologies meant that the V3-V4 region performed equally well. Both approaches presented very good agreement with qPCR quantification of key taxa, provided that an appropriate bioinformatic pipeline was used. Shotgun metagenomic sequencing presents an interesting alternative to 16S rRNA gene amplification and sequencing but requires deeper sequencing and more bioinformatic expertise and infrastructure. We assessed different tools for the removal of host reads and the taxonomic annotation of metagenomic reads, including a new, easy-to-build and -use reference database of vaginal taxa. This curated database performed as well as the best-performing previously published strategies. Despite the many advantages of shotgun sequencing, none of the shotgun approaches assessed here agreed with the qPCR data as well as the 16S rRNA gene sequencing.IMPORTANCE The vaginal microbiome has been connected to various aspects of host health, including susceptibility to sexually transmitted infections as well as gynecological cancers and pregnancy outcomes. This has led to a thriving research environment but also to conflicting available methodologies, including many studies that do not report their molecular biological and bioinformatic methods in sufficient detail to be considered reproducible. This can lead to conflicting messages and delay progress from descriptive to intervention studies. By systematically assessing best practices for the characterization of the human vaginal microbiome, this study will enable past studies to be assessed more critically and assist future studies in the selection of appropriate methods for their specific research questions.
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159
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Dareng EO, Ma B, Adebamowo SN, Famooto A, Ravel J, Pharoah PP, Adebamowo CA. Vaginal microbiota diversity and paucity of Lactobacillus species are associated with persistent hrHPV infection in HIV negative but not in HIV positive women. Sci Rep 2020; 10:19095. [PMID: 33154533 PMCID: PMC7644686 DOI: 10.1038/s41598-020-76003-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 10/22/2020] [Indexed: 01/22/2023] Open
Abstract
The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomavirus (hrHPV) infection. We examined the relationship between the vaginal microbiota and persistent hrHPV infection in HIV-negative and HIV-positive women. We used 16S-rRNA sequencing to characterize the vaginal microbiota of two serial samples taken six months apart from 211 Nigerian women (67%, 142/211 HIV-positive and 33%, 69/211 HIV-negative) and evaluated the association between the vaginal microbiota and persistent hrHPV infection using generalized estimating equation logistic regression models and linear discriminant analysis effect size (LEfSe) algorithm to identify phylotypic biomarkers of persistent hrHPV infection. The high diversity microbiota, Community State Type IV-B, was the most prevalent in both HIV-negative (38% at baseline, 30% at the follow-up visit) and HIV-positive (27% at baseline, 35% at the follow-up visit) women. The relationship between the vaginal microbiota and persistent hrHPV was modified by HIV status. In HIV-negative women, women with Lactobacillus dominant microbiota had lower odds (OR: 0.35, 95% CI 0.14-0.89, p = 0.03) of persistent hrHPV compared to women with Lactobacillus deficient microbiota. While among HIV-positive women, the odds of being persistently infected with hrHPV was higher in women with Lactobacillus dominant microbiota (OR: 1.25, 95% CI 0.73-2.14 p = 0.41). This difference in effect estimates by HIV was statistically significant (p = 0.02). A high diversity vaginal microbial community with paucity of Lactobacillus species was associated with persistent hrHPV infection in HIV-negative women but not in HIV-positive women.
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Affiliation(s)
- Eileen O Dareng
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK.,Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Bing Ma
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sally N Adebamowo
- Department of Epidemiology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Center for Bioethics and Research Ibadan, Ibadan, Nigeria
| | | | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul P Pharoah
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK
| | - Clement A Adebamowo
- Institute of Human Virology Nigeria, Abuja, Nigeria. .,Department of Epidemiology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA. .,Center for Bioethics and Research Ibadan, Ibadan, Nigeria. .,Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA.
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160
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Haahr T, Freiesleben NLC, Pinborg A, Nielsen HS, Hartvig V, Mikkelsen AL, Parks T, Uldbjerg N, Jensen JS, Humaidan P. Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial. BMJ Open 2020; 10:e035866. [PMID: 33051228 PMCID: PMC7554508 DOI: 10.1136/bmjopen-2019-035866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Recent studies in in vitro fertilisation (IVF) patients have associated abnormal vaginal microbiota (AVM) with poor clinical pregnancy rates of 6%-9% per embryo transfer. The biological plausibility for this finding is hypothesised to be ascending infection to the endometrium which in turn hampers embryo implantation. New molecular based diagnosis may offer advantages compared to microscopical diagnosis of AVM which has huge inter-study variability ranging from 4 to 38%; however, the important question is whether screening and treatment of AVM would improve reproductive outcomes in IVF patients. Herein, we describe a protocol for an ongoing double-blind, placebo-controlled multicentre trial of IVF patients diagnosed with AVM and randomised in three parallel groups 1:1:1. METHODS AND ANALYSIS This is a drug intervention study where IVF patients will be screened for AVM, using a qPCR assay targeting Atopobium vaginae and Gardnerella vaginalis. If positive, patients will be randomised to one of the three study arms. The first arm consists of clindamycin 300 mg ×2 daily for 7 days followed by vaginal Lactobacillus crispatus CTV-05 until clinical pregnancy scan week 7-9. The second arm consists of clindamycin and placebo L. crispatus CTV-05, whereas patients in the third arm will be treated with placebo/placebo. We used a superiority design to estimate that active treatment in both arms will increase the primary outcome, clinical pregnancy rate per embryo transfer, from 20% to 40%. A potential difference between the two active arms was considered exploratory. With a power of 80% and an alpha at 5%, the sample size is estimated to be 333 patients randomised. A pre-planned interim analysis is scheduled at 167 patients randomised. ETHICS AND DISSEMINATION All patients have to give informed consent. Dissemination of results is ensured in clinical trial agreements whether they be positive or not. Ethics committee, Central Denmark Region approved this protocol. TRIAL REGISTRATION NUMBER ICH-GCP monitored trial, EudraCT 2016-002385-31; Pre-results.
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Affiliation(s)
- Thor Haahr
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | | | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Anne-Lis Mikkelsen
- The Fertility Clinic, Sjællands Universitetshospital Køge, Koge, Sjaelland, Denmark
| | | | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Jørgen Skov Jensen
- Department of Reproductive Microbiology, Statens Serum Institute, Copenhagen, Denmark
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
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Cheng L, Norenhag J, Hu YOO, Brusselaers N, Fransson E, Ährlund-Richter A, Guðnadóttir U, Angelidou P, Zha Y, Hamsten M, Schuppe-Koistinen I, Olovsson M, Engstrand L, Du J. Vaginal microbiota and human papillomavirus infection among young Swedish women. NPJ Biofilms Microbiomes 2020; 6:39. [PMID: 33046723 PMCID: PMC7552401 DOI: 10.1038/s41522-020-00146-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases. To define the HPV-associated microbial community among a high vaccination coverage population, we carried out a cross-sectional study with 345 young Swedish women. The microbial composition and its association with HPV infection, including 27 HPV types, were analyzed. Microbial alpha-diversity was found significantly higher in the HPV-infected group (especially with oncogenic HPV types and multiple HPV types), compared with the HPV negative group. The vaginal microbiota among HPV-infected women was characterized by a larger number of bacterial vaginosis-associated bacteria (BVAB), Sneathia, Prevotella, and Megasphaera. In addition, the correlation analysis demonstrated that twice as many women with non-Lactobacillus-dominant vaginal microbiota were infected with oncogenic HPV types, compared with L. crispatus-dominated vaginal microbiota. The data suggest that HPV infection, especially oncogenic HPV types, is strongly associated with a non-Lactobacillus-dominant vaginal microbiota, regardless of age and vaccination status.
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Affiliation(s)
- Liqin Cheng
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Johanna Norenhag
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Yue O O Hu
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Unnur Guðnadóttir
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Pia Angelidou
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Yinghua Zha
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Marica Hamsten
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - Ina Schuppe-Koistinen
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Juan Du
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
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Berggrund M, Gustavsson I, Aarnio R, Lindberg JH, Sanner K, Wikström I, Enroth S, Bunikis I, Olovsson M, Gyllensten U. Temporal changes in the vaginal microbiota in self-samples and its association with persistent HPV16 infection and CIN2. Virol J 2020; 17:147. [PMID: 33028395 PMCID: PMC7541248 DOI: 10.1186/s12985-020-01420-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vaginal microbiota has been reported to be associated with HPV infection and cervical cancer. This study was performed to compare the vaginal microbiota at two timepoints in women performing self-sampling and had a persistent or transient HPV16 infection. The women were tested for 12 high-risk HPV (hrHPV) types but only women with single type (HPV16) were included to reduce confounding variables. Methods In total 96 women were included in this study. Of these, 26 were single positive for HPV16 in the baseline test and HPV negative in the follow-up test and 38 were single positive for HPV16 in both tests and diagnosed with CIN2+ in histology. In addition, 32 women that were negative for all 12 HPV tested were included. The samples of vaginal fluid were analyzed with the Ion 16S™ Metagenomics Kit and Ion 16S™ metagenomics module within the Ion Reporter™ software. Results K-means clustering resulted in two Lactobacillus-dominated groups, one with Lactobacillus sp. and the other specifically with Lactobacillus iners. The two remaining clusters were dominated by a mixed non-Lactobacillus microbiota. HPV negative women had lower prevalence (28%) of the non-Lactobacill dominant cluster in the baseline test, as compared to women with HPV16 infection (42%) (p value = 0.0173). Transition between clusters were more frequent in women with persistent HPV16 infection (34%) as compared in women who cleared the HPV16 infection (19%) (p value = 0.036). Conclusions The vaginal microbiota showed a higher rate of transitioning between bacterial profiles in women with persistent HPV16 infection as compared to women with transient infection. This indicate an instability in the microenvironment in women with persistent HPV infection and development of CIN2+.
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Affiliation(s)
- Malin Berggrund
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Ignas Bunikis
- Uppsala Genome Center, Science for Life Laboratory, Department of Immunology, Genetics, and Pathology, Uppsala University, BMC, Box 815, 752 37, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden.
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Moscicki AB, Shi B, Huang H, Barnard E, Li H. Cervical-Vaginal Microbiome and Associated Cytokine Profiles in a Prospective Study of HPV 16 Acquisition, Persistence, and Clearance. Front Cell Infect Microbiol 2020; 10:569022. [PMID: 33102255 PMCID: PMC7546785 DOI: 10.3389/fcimb.2020.569022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Persistent human papillomavirus (HPV) infections is necessary for the development of cervical cancers. Consequently, understanding the biologic mechanisms resulting in clearance is key in cancer prevention. Similar to other mucosal sites, it is expected that the local microbiome plays a significant role in shaping the immune response responsible for HPV clearance. Using cervical wash repository samples from a prospective study of HPV in women, this study investigates the microbiome and its associated inflammatory milieu during HPV 16 pre-acquisition, persistence and clearance states. For comparison, samples from women with no history of HPV ever during the study period were selected. We showed that 9 of 13 inflammatory cytokines were found to be significantly increased in the immediate post-clearance visit compared to the pre-acquisition or infection visits. Gardnerella vaginalis was associated with higher levels of inflammatory cytokines. Women with no history of HPV infection had similar cytokine profiles as those with HPV 16 post-clearance. This in vivo study documented an immune response shortly after HPV 16 clearance. G. vaginalis appeared to be involved in shaping this immune response. The appearance of G. vaginalis may have resulted from a shift from anti-microbial to anti-viral immune response with loss of bacterial control. The similar high levels of cytokines seen in women with no history of HPV suggest that a certain level of inflammatory surveillance is required to maintain an HPV negative state. This data may inform therapies such as probiotics or pro-inflammatory agents for treatment of persistent HPV.
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Affiliation(s)
- Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Baochen Shi
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hazel Huang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma Barnard
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, United States
| | - Huiying Li
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, United States
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Tozetto-Mendoza TR, Bongiovanni AM, Minis E, Linhares IM, Boester A, Freire WS, Lima SH, de Oliveira NPG, Mendes-Correa MC, Forney LJ, Witkin SS. Torquetenovirus Titer in Vaginal Secretions from Pregnant and Postpartum Women: Association with Absence of Lactobacillus crispatus and Levels of Lactic Acid and Matrix Metalloproteinase-8. Reprod Sci 2020; 27:2075-2081. [PMID: 32944879 DOI: 10.1007/s43032-020-00227-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022]
Abstract
Vaginal samples from women with term deliveries were tested for torquetenovirus (TTV) by gene amplification, matrix metalloproteinase (MMP)-8 and D- and L-lactic acid by ELISA, and microbiome composition by analysis of the bacterial 16S ribosomal RNA gene. TTV was detected in 43.2%, 31.5%, and 41.4% of first trimester, third trimester, and postpartum samples, respectively. The viral titer was higher in postpartum than in the first (p = 0.0018) or third (p = 0.0013) trimester. The mean gestational age at delivery was lower in women positive for TTV in their first trimester (p = 0.0358). In the first and third trimester, the MMP-8 level was higher if TTV was also present (p < 0.0091). The D-lactic acid level was lower in first trimester samples if TTV was present (p = 0.0334). Lactobacillus crispatus dominance in first and third trimester samples was higher when TTV was absent (p < 0.0033). We conclude that TTV is present in the vagina in many women with normal pregnancy outcomes and that its occurrence is associated with a lack of L. crispatus dominance, an increase in vaginal MMP-8 and a decrease in D-lactic acid.
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Affiliation(s)
- Tania R Tozetto-Mendoza
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil.
| | | | - Evelyn Minis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Iara M Linhares
- Department of Gynecology and Obstetrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Allison Boester
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Wilton S Freire
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil
| | - Silvia H Lima
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil
| | - Natan P G de Oliveira
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil
| | - Maria C Mendes-Correa
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil
| | - Larry J Forney
- Department of Biological Sciences and the Institute for Bioinformatics and Evolutionary Studies, University of Idaho, Moscow, ID, USA
| | - Steven S Witkin
- Virology laboratory (LIM 52), Tropical Medicine Institute, Medicine School, São Paulo University, Rua Dr. Enéas de Carvalho Aguiar, 470, Cerqueira Cesar, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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165
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Changes of vaginal microbiota during cervical carcinogenesis in women with human papillomavirus infection. PLoS One 2020; 15:e0238705. [PMID: 32941440 PMCID: PMC7498004 DOI: 10.1371/journal.pone.0238705] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the changes of vaginal microbiota during cervical carcinogenesis in women with high-risk human papillomavirus infection. Materials and methods Vaginal microbiota was analyzed using next-generation sequencing in women with normal, cervical intraepithelial neoplasia (CIN), or cervical cancer. Results A marked decrease of Lactobacillus crispatus was found in the CIN/cancer groups compared with that in the normal group. The diversity of microorganisms increased in patients with CIN or cervical cancer with HPV infection. Atopobium vaginae (OR 4.33, 95% CI 1.15–16.32), Dialister invisus (OR 4.89, 95% CI 1.20–19.94), Finegoldia magna (OR 6.00, 95% CI 1.08–33.27), Gardnerella vaginalis (OR 7.43, 95% CI 1.78–31.04), Prevotella buccalis (OR 11.00, 95% CI 2.00–60.57), and Prevotella timonensis (OR 6.00, 95% CI 1.46–24.69) were significantly associated with the risk of CIN 2/3 or cervical cancer. Conclusion Women with the CIN and cervical cancer showed a high diversity in vaginal microbiota. Depletion of Lactobacillus crispatus and increased abundance of anaerobic bacteria were detected in women with cervical disease.
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Coinfection of High-Risk Human Papillomavirus and Lower Genital Tract Pathogens in the Development of High-Grade Cervical Lesions. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:7640758. [PMID: 32908620 PMCID: PMC7477613 DOI: 10.1155/2020/7640758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Abstract
Purpose This study investigated the infection status and relationship between other common lower genital tract infectious pathogens and high-risk human papillomavirus (HR-HPV) in the high-grade cervical lesions. Methods Overall, 882 patients were enrolled in this retrospective study, of which 339 patients (≥HSIL group) were confirmed with high-grade squamous intraepithelial lesions (HSIL) or cervical squamous cell carcinoma (SCC), while 543 patients (≤LSIL group) were diagnosed with low-grade squamous intraepithelial lesions (LSIL) or normal cervical pathology diagnosis. Cervical swab specimens were tested for HPV, pathogenic bacteria (PB), U. urealyticum (UU), M. hominis (MH), and C. trachomatis (CT) in both groups. Results The infection rates of HR-HPV, PB, UU (at high density), and CT were higher in the ≥HSIL group than in the ≤LSIL group (P < 0.001); however, higher infection rates with MH were not observed (P > 0.05). PB, UU, and CT were associated with HR-HPV infection (P < 0.001). The PB and UU infection rates in the ≥HSIL group were significantly different from those in the ≤LSIL group, regardless of whether there was an HR-HPV infection at the same time (P < 0.05). However, this was not the case for the CT (P > 0.05). Furthermore, 259 pathogenic bacterial strains were detected in 882 cases. The difference in the distribution of pathogenic bacterial flora in the different grades of cervical lesions had no statistical significance, which was prioritized over Escherichia coli (P > 0.05). Conclusion PB, UU, and CT infection is associated with susceptibility to HR-HPV, HR-HPV coinfection with these pathogens might increase the risk of high-grade cervical lesions, and PB and UU might be independent risk factors for cervical lesions.
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Chen Y, Qiu X, Wang W, Li D, Wu A, Hong Z, Di W, Qiu L. Human papillomavirus infection and cervical intraepithelial neoplasia progression are associated with increased vaginal microbiome diversity in a Chinese cohort. BMC Infect Dis 2020; 20:629. [PMID: 32842982 PMCID: PMC7449047 DOI: 10.1186/s12879-020-05324-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In this study, the association between human papillomavirus (HPV) infection and related cervical intraepithelial neoplasia (CIN) or cervical cancer and vaginal microbiome was evaluated in Chinese cohorts. METHODS The vaginal bacterial composition of five groups, HPV-infected women without CINs (HPV, n = 78), women with low-grade squamous intraepithelial lesions (LSIL, n = 51), women with high-grade squamous intraepithelial lesions (HSIL, n = 23), women with invasive cervical cancer (Cancer, n = 9) and healthy women without HPV infection (Normal, n = 68), was characterized by deep sequencing of barcoded 16S rRNA gene fragments (V3-4) using Illumina MiSeq. RESULTS HPV infection increased vaginal bacterial richness and diversity regardless of the status of CINs. The vaginal bacterial richness and diversity were further augmented in women with cervical cancer. Lactobacillus was the most abundant genus in all groups. HPV infection had a negative influence on the abundances of Lactobacillus, Gardnerella and Atopobium. Accordingly, HPV infection increased the relative abundance of Prevotella, Bacillus, Anaerococcus, Sneathia, Megasphaera, Streptococcus and Anaerococcus. The increased proportions of Bacillus, Anaerococcus and the reduced abundance of Gradnerella vaginalis were probably related with the progression of CINs severity. HPV infection without CINs or cancerous lesions was strongly associated with Megasphaera. The most abundant bacterium in the LSIL group was Prevotella amnii. However, Prevotella timonensis, Shuttleworthia and Streptococcaceae at the family level were three taxa related to HSIL. Furthermore, more taxa were associated with the Cancer group including Bacillus, Sneathia, Acidovorax, Oceanobacillus profundus, Fusobacterium, Veillonellaceae at the family level, Anaerococcus and Porphyromonas uenonis. Samples in the Normal group were mostly assigned to CST III. HPV infection converted the vaginal bacterial community structure from CST III to CST IV. Furthermore, the proportions of CST IV were gradually augmented with the progression of the severity of CINs. CONCLUSIONS This work interpreted the differential vaginal bacteria under HPV infection and various precancerous or cancerous lesions in a Chinese cohort. We distinguished the specific microbes and the vaginal bacterial structure that were related with the progression of CINs severity in Chinese women.
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Affiliation(s)
- Yulian Chen
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xingdi Qiu
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjing Wang
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Li
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Anyue Wu
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zubei Hong
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Di
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Lihua Qiu
- Department of Gynecology and Obstetrics, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Aydin AM, Chahoud J, Adashek JJ, Azizi M, Magliocco A, Ross JS, Necchi A, Spiess PE. Understanding genomics and the immune environment of penile cancer to improve therapy. Nat Rev Urol 2020; 17:555-570. [DOI: 10.1038/s41585-020-0359-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
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Łaniewski P, Cui H, Roe DJ, Chase DM, Herbst-Kralovetz MM. Vaginal microbiota, genital inflammation, and neoplasia impact immune checkpoint protein profiles in the cervicovaginal microenvironment. NPJ Precis Oncol 2020; 4:22. [PMID: 32802959 PMCID: PMC7398915 DOI: 10.1038/s41698-020-0126-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
Emerging evidence suggests that the vaginal microbiota play a role in HPV persistence and cervical neoplasia development and progression. Here we examine a broad range of immune checkpoint proteins in the cervicovaginal microenvironment across cervical carcinogenesis and explore relationships among these key immunoregulatory proteins, the microbiota composition, and genital inflammation. First, we demonstrate that immune checkpoint molecules can be measured in cervicovaginal lavages. Secondly, we identify CD40, CD27, and TIM-3 to specifically discriminate cervical cancer from other groups and CD40, CD28, and TLR2 to positively correlate to genital inflammation. Finally, PD-L1 and LAG-3 levels negatively, whereas TLR2 positively correlate to health-associated Lactobacillus dominance. Overall, our study identifies immune checkpoint signatures associated with cervical neoplasm and illuminates the multifaceted microbiota-host immunity network in the local microenvironment. This study provides a foundation for future mechanistic studies and highlights the utility of cervicovaginal lavage profiling for predicting and monitoring response to cancer therapy.
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Affiliation(s)
- Paweł Łaniewski
- Department of Basic Medical Sciences, College of Medicine—Phoenix, University of Arizona, Phoenix, AZ USA
| | - Haiyan Cui
- UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ USA
| | - Denise J. Roe
- UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ USA
| | - Dana M. Chase
- UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ USA
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA
- Valleywise Health Medical Center, Phoenix, AZ USA
- Dignity Health St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
- US Oncology, Phoenix, AZ USA
| | - Melissa M. Herbst-Kralovetz
- Department of Basic Medical Sciences, College of Medicine—Phoenix, University of Arizona, Phoenix, AZ USA
- UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ USA
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, AZ USA
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170
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Musa J, Mehta SD, Achenbach CJ, Evans CT, Jordan N, Magaji FA, Pam VC, Daru PH, Silas OA, Sagay AS, Anorlu R, Zheng Y, Maiga M, Adewole IF, Murphy RL, Hou L, Simon MA. HIV and development of epithelial cell abnormalities in women with prior normal cervical cytology in Nigeria. Infect Agent Cancer 2020; 15:50. [PMID: 32760435 PMCID: PMC7392708 DOI: 10.1186/s13027-020-00316-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background HIV-associated cellular immune dysfunction has been linked to higher risk of cervical dysplasia and cancer in HIV infected women. We sought to understand the relationship between HIV and development of epithelial cell abnormalities (ECA) at follow-up in women with prior normal cervical cytology (NCC). Methods Retrospective cohort analysis of women who received a Pap test at the Operation Stop Cervical Cancer Unit in Jos, Nigeria over a 10-year period (2006-2016). We analyzed the data of women with NCC at first Pap who had at least one follow-up cytology result for time-to-detection of ECA. We determined follow-up time in years from date of first NCC to date of first ECA report or date of last NCC follow up report with censoring at last follow-up date or December 31st, 2016 whichever came first. The primary outcome was development of any ECA as defined by the Bethesda 2001 reporting system. We identified demographic and clinical factors associated with incident ECA using multivariable Cox regression. Results A total of 1599 women were eligible for this analysis. Overall, 3.7% (57/1556) of women reported being HIV infected. The median age at first Pap was 39 years (IQR; 33-45). The HIV infected women were younger (36.3 ± 8.1) compared to those uninfected (39.3 ± 6.6), p = 0.005. After an accrued follow-up time of 3809 person-years (PYs), 243 women (15%) had an ECA with an event rate of 6.38 per 100 PYs. Women ≥35 years at first Pap were more likely to have an ECA compared to those < 35 years (7.5 per 100 PYs vs 3.8 per 100 PYs, HR = 1.96; 95% CI: 1.4, 2.8). HIV status was not significantly associated with developing ECA in either unadjusted (7.4 per 100 PYs vs 6.4 per 100 PYs, HR = 1.17; 95% CI: 0.53, 2.3) or adjusted analyses (aHR = 1.78; 95% CI: 0.87, 3.65). Conclusion Women living with HIV and on successful antiretroviral treatment may not have a differential hazard in the development of ECA during follow up after a prior normal Pap. Offering a repeat CCS to women who are 35 years or older irrespective of HIV status is likely an effective strategy in resource limited settings.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria.,Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Supriya D Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
| | - Chad J Achenbach
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Charlesnika T Evans
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA.,Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA.,Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Victor C Pam
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Olugbenga A Silas
- Department of Pathology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Jos, Nigeria
| | - Yinan Zheng
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Mamoudou Maiga
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Techniques and Technologies of Bamako, University of Sciences, Bamako, Mali
| | - Isaac F Adewole
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Robert L Murphy
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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171
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Daily Vaginal Microbiota Fluctuations Associated with Natural Hormonal Cycle, Contraceptives, Diet, and Exercise. mSphere 2020; 5:5/4/e00593-20. [PMID: 32641429 PMCID: PMC7343982 DOI: 10.1128/msphere.00593-20] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The vaginal microbiome is a critical component of women’s sexual and reproductive health, with variations in microbial composition, particularly the loss of Lactobacillus species, being implicated in gynecologic and obstetric diseases. Given that the vaginal microbiome is so crucial, why do vaginal microbial profiles vary strikingly from person to person and even change over time within the same person? In the present study, which tracked the daily vaginal microbiomes of young healthy women through different lifestyles, we found that use of a locally released progestin contraceptive, a vegetarian diet, and intense exercise appear to lead to vaginal microbiome alterations and loss of Lactobacillus species. The impact of these vaginal microbiome changes on immediate and long-term health remain to be investigated. The microorganisms of the vaginal tract are critical for vaginal and reproductive health. However, the regulation of these microorganisms is not well understood. Therefore, we investigated whether different factors regulate the vaginal microbiota of healthy college-aged women (n = 26) with high temporal resolution by collecting daily self-administered vaginal swabs and using 16S rRNA sequencing for bacterial identification. As expected, vaginal microbiota clustered into five predefined community state types. Vaginal microbial diversity, stability, and Lactobacillus abundances were associated with the menstrual cycle and hormonal contraceptive use. Vaginal microbial diversity, as measured using the Shannon index, increased during menses (P < 0.001), while Lactobacillus abundances decreased (P = 0.01). The covariance of these microbial measures with previously established estradiol levels suggests that estrogens can regulate vaginal microbiota. Moreover, the use of hormonal contraceptives may alter the temporal dynamics of the vaginal microbiota and decrease Lactobacillus abundances, depending on hormonal content and release method. Interestingly, intrasample diversity was greater in participants on a vegetarian diet (P = 0.004) and among participants who exercised more (P = 0.04). These findings indicate that ovarian hormones, diet, and exercise can regulate vaginal microbial composition and stability and may impact vaginal and reproductive health. IMPORTANCE The vaginal microbiome is a critical component of women’s sexual and reproductive health, with variations in microbial composition, particularly the loss of Lactobacillus species, being implicated in gynecologic and obstetric diseases. Given that the vaginal microbiome is so crucial, why do vaginal microbial profiles vary strikingly from person to person and even change over time within the same person? In the present study, which tracked the daily vaginal microbiomes of young healthy women through different lifestyles, we found that use of a locally released progestin contraceptive, a vegetarian diet, and intense exercise appear to lead to vaginal microbiome alterations and loss of Lactobacillus species. The impact of these vaginal microbiome changes on immediate and long-term health remain to be investigated.
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172
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Donmez HG, Sahal G, Akgor U, Cagan M, Ozgul N, Beksac MS. The relationship between the presence of HPV infection and biofilm formation in cervicovaginal smears. Infection 2020; 48:735-740. [PMID: 32623704 DOI: 10.1007/s15010-020-01478-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To demonstrate and understand the association of HPV infection and biofilm formation. METHODS The study consisted of cervicovaginal samples of 72 women who were evaluated at the colposcopy unit. Papanicolaou staining was used for cytological examination while "Crystal Violet Binding" assay was performed to detect biofilm formation. RESULTS HPV-DNA was positive in 55.5% (n = 40) of the patients. The biofilm formation rate was statistically significantly higher in the HPV-positive women (45%) compared to HPV-negative women (21.9%) (P < 0.05). There was a statistically significant relationship between the presence of single HPV and "high-risk HPV" types and biofilm formation (P < 0.05). Biofilm formation was found in 80% of women with abnormal smear demonstrating atypical epithelial cells (P < 0.05). CONCLUSION Biofilm formation is more frequent at the cervicovaginal microbiota of patients with HPV infection. This finding is especially important in cases with atypical epithelial cells at their cervicovaginal smears.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey.
| | - Gulcan Sahal
- Department of Biology, Faculty of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey
| | - Utku Akgor
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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173
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Zhang T, Xue Y, Yue T, Xiong L, Wang X, Wang W, Liu Y, An R. Characteristics of aerobic vaginitis among women in Xi'an district: a hospital-based study. BMC Womens Health 2020; 20:138. [PMID: 32605571 PMCID: PMC7325369 DOI: 10.1186/s12905-020-00997-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aerobic vaginitis (AV) is a reproductive tract infection that affects health of women. The objective of this study was to analyze the characteristics of simple and mixed AV patients in Xi'an district and provide reference data for the clinical treatment of AV. METHODS Patients were recruited from the outpatient Department of Obstetrics and Gynecology in the First Affiliated Hospital of Xi'an Jiaotong University from September 2014 to April 2019 in strict accordance with inclusion and exclusion criteria. The study principally examined the vaginal ecosystem, age distribution, levels of functional enzymes, and changes in pH levels in these women. Differences within groups were analyzed. RESULTS A total of 284 AV patients were enrolled to investigate the distribution of simple and mixed AV infection. AV infection was found to be mainly simple infection. Simple AV patients were generally aged 50-60 years, while mixed AV patients were mostly aged 30-40 years. In the present study, the density of vaginal bacteria (OR = 13.294, 95% CI = 5.869-30.115, P < 0.01), the type of predominant bacteria (OR = 3.962, 95% CI = 1.785-7.984, P < 0.01) and positive expression of coagulase (OR = 3.789, 95% CI = 1.798-7.984, P < 0.01) were considered risk factors for mixed AV infection. CONCLUSIONS The epidemiology of simple and mixed AV infection were found to be different, with density of vaginal bacteria (I or IV), species that are predominant and levels of coagulase being risk factors for mixed AV infection.
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Affiliation(s)
- Taohong Zhang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Yan Xue
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Ting Yue
- Department of Obstetrics and Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Lili Xiong
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Xiaowei Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Weihong Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Ying Liu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China
| | - Ruifang An
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, No.277, Yanta Western Road, Xi'an, 710061, Shaanxi Province, China.
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174
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Bovbjerg ML, Cheyney M. Current Resources for Evidence-Based Practice, July 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:391-404. [PMID: 32574584 PMCID: PMC7305877 DOI: 10.1016/j.jogn.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of whether it is ethical not to offer doula care to all women, and commentaries on reviews focused on folic acid and autism spectrum disorder, and timing of influenza vaccination during pregnancy.
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175
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The vaginal microbiota associates with the regression of untreated cervical intraepithelial neoplasia 2 lesions. Nat Commun 2020; 11:1999. [PMID: 32332850 PMCID: PMC7181700 DOI: 10.1038/s41467-020-15856-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Emerging evidence suggests associations between the vaginal microbiota (VMB) composition, human papillomavirus (HPV) infection, and cervical intraepithelial neoplasia (CIN); however, causal inference remains uncertain. Here, we use bacterial DNA sequencing from serially collected vaginal samples from a cohort of 87 adolescent and young women aged 16–26 years with histologically confirmed, untreated CIN2 lesions to determine whether VMB composition affects rates of regression over 24 months. We show that women with a Lactobacillus-dominant microbiome at baseline are more likely to have regressive disease at 12 months. Lactobacillus spp. depletion and presence of specific anaerobic taxa including Megasphaera, Prevotella timonensis and Gardnerella vaginalis are associated with CIN2 persistence and slower regression. These findings suggest that VMB composition may be a future useful biomarker in predicting disease outcome and tailoring surveillance, whilst it may offer rational targets for the development of new prevention and treatment strategies. Persistent infection with human papillomavirus can lead to cervical intraepithelial neoplasia (CIN). Here, the authors profile the vaginal microbiota in a cohort of non-pregnant young women diagnosed with CIN2 and find that absence of Lactobacillusspp. and presence of a diverse population of strict anaerobes associates with a decreased regression of untreated CIN2 lesions.
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176
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Łaniewski P, Ilhan ZE, Herbst-Kralovetz MM. The microbiome and gynaecological cancer development, prevention and therapy. Nat Rev Urol 2020; 17:232-250. [PMID: 32071434 PMCID: PMC9977514 DOI: 10.1038/s41585-020-0286-z] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/16/2022]
Abstract
The female reproductive tract (FRT), similar to other mucosal sites, harbours a site-specific microbiome, which has an essential role in maintaining health and homeostasis. In the majority of women of reproductive age, the microbiota of the lower FRT (vagina and cervix) microenvironment is dominated by Lactobacillus species, which benefit the host through symbiotic relationships. By contrast, the upper FRT (uterus, Fallopian tubes and ovaries) might be sterile in healthy individuals or contain a low-biomass microbiome with a diverse mixture of microorganisms. When dysbiosis occurs, altered immune and metabolic signalling can affect hallmarks of cancer, including chronic inflammation, epithelial barrier breach, changes in cellular proliferation and apoptosis, genome instability, angiogenesis and metabolic dysregulation. These pathophysiological changes might lead to gynaecological cancer. Emerging evidence shows that genital dysbiosis and/or specific bacteria might have an active role in the development and/or progression and metastasis of gynaecological malignancies, such as cervical, endometrial and ovarian cancers, through direct and indirect mechanisms, including modulation of oestrogen metabolism. Cancer therapies might also alter microbiota at sites throughout the body. Reciprocally, microbiota composition can influence the efficacy and toxic effects of cancer therapies, as well as quality of life following cancer treatment. Modulation of the microbiome via probiotics or microbiota transplant might prove useful in improving responsiveness to cancer treatment and quality of life. Elucidating these complex host-microbiome interactions, including the crosstalk between distal and local sites, will translate into interventions for prevention, therapeutic efficacy and toxic effects to enhance health outcomes for women with gynaecological cancers.
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Affiliation(s)
- Paweł Łaniewski
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Zehra Esra Ilhan
- Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Melissa M. Herbst-Kralovetz
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ, USA,Correspondence:
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177
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Klein C, Kahesa C, Mwaiselage J, West JT, Wood C, Angeletti PC. How the Cervical Microbiota Contributes to Cervical Cancer Risk in Sub-Saharan Africa. Front Cell Infect Microbiol 2020; 10:23. [PMID: 32117800 PMCID: PMC7028704 DOI: 10.3389/fcimb.2020.00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/15/2020] [Indexed: 12/29/2022] Open
Abstract
Despite ongoing efforts, sub-Saharan Africa faces a higher cervical cancer burden than anywhere else in the world. Besides HPV infection, definitive factors of cervical cancer are still unclear. Particular states of the cervicovaginal microbiota and viral infections are associated with increased cervical cancer risk. Notably, HIV infection, which is prevalent in sub-Saharan Africa, greatly increases risk of cervicovaginal dysbiosis and cervical cancer. To better understand and address cervical cancer in sub-Saharan Africa, a better knowledge of the regional cervicovaginal microbiome is required This review establishes current knowledge of HPV, HIV, cervicovaginal infections, and the cervicovaginal microbiota in sub-Saharan Africa. Because population statistics are not available for the region, estimates are derived from smaller cohort studies. Microbiota associated with cervical inflammation have been found to be especially prevalent in sub-Saharan Africa, and to associate with increased cervical cancer risk. In addition to high prevalence and diversity of HIV and HPV, intracellular bacterial infections such as Chlamydia, Gonorrhea, and Mycoplasma hominis are much more common than in regions with a low burden of cervical cancer. This suggests the prevalence of cervical cancer in sub-Saharan Africa may be partially attributed to increased cervical inflammation resulting from higher likelihood of cervical infection and/or microbial dysbiosis.
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Affiliation(s)
- Cameron Klein
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | | | | | - John T West
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Charles Wood
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Peter C Angeletti
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
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178
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Cheng Y, Yang S, Shen Y, Ding B, Wu W, Zhang Y, Liang G. The Role of High-Risk Human Papillomavirus-Related Long Non-Coding RNAs in the Prognosis of Cervical Squamous Cell Carcinoma. DNA Cell Biol 2020; 39:645-653. [PMID: 32045269 DOI: 10.1089/dna.2019.5167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer (CC) is a malignant tumor that could seriously endanger women's life and health, of which cervical squamous cell carcinoma (CESC) accounts for more than 80%. High-risk human papillomavirus (HR-HPV) infection is the primary cause of CC. The 5-year survival rate is low due to poor prognosis. We need to explore the pathogenesis of CC and seek effective biomarkers to improve prognosis. The purpose of this research is to construct an HR-HPV-related long non-coding RNA (lncRNA) signature for predicting the survival and finding the biomarkers related to CC prognosis. First, we downloaded the CESC data from The Cancer Genome Atlas (TCGA) database to find HR-HPV-related lncRNAs in CC. Then, the differentially expressed lncRNAs were analyzed by univariate and multivariate Cox regression. Six lncRNAs were found to be associated with the prognosis and can be used as independent prognostic factors. Next, based on these prognostic genes, we established a risk score model, which showed that patients with higher score had poorer prognosis and higher mortality. Moreover, the Kaplan-Meier curve of the model indicated that the model was statistically significant (p < 0.05). The survival-receiver operating characteristic curve showed that the model could also predict the survival of CC patients (the area under the curve, AUC = 0.65). More importantly, nomogram was drawn with clinical features and risk score, which verified the above conclusion, and its calibration curve and c-index index fully demonstrated that the prediction model could predict the progress of CC. We also validated the risk score model in head and neck cancer, and the results indicated that the model had obvious prognostic ability. Finally, we analyzed the correlation between clinical features and survival, and found that neoplasm cancer (p < 0.000) and risk score (p < 0.000) were independent prognostic factors for CC. In conclusion, the study established HR-HPV-related lncRNA signature, which provided a reliable prognostic tool, and was of great significance for finding the biomarkers related to HR-HPV infection in CC.
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Affiliation(s)
- Yanping Cheng
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Sheng Yang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Yang Shen
- Zhongda Hospital, Nanjing, Jiangsu, P.R. China
| | - Bo Ding
- Zhongda Hospital, Nanjing, Jiangsu, P.R. China
| | - Wenjuan Wu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Yanqiu Zhang
- Department of Environmental Occupational Health, Taizhou Center for Disease Control and Prevention, Taizhou City, Jiangsu, P.R. China
| | - Geyu Liang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
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Digesu GA, Vieira‐Baptista P, Tailor V, Stockdale C, Preti M. Response letter to comments related to “The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document”. Neurourol Urodyn 2020; 39:473-476. [DOI: 10.1002/nau.24229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Pedro Vieira‐Baptista
- Department of Obstetrics and Gynecology Hospital Lusíadas Porto Porto Portugal
- Lower Genital Tract Unit Centro Hospitalar de São João Porto Portugal
| | - Visha Tailor
- Department of Urogynaecology Imperial College Healthcare London UK
| | - Colleen Stockdale
- Department of Obstetrics and Gynecology University of Iowa Iowa City Iowa
| | - Mario Preti
- Department of Obstetrics and Gynecology University of Torino Torino Italy
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