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Cui M, Song L, Mao R, Lyu Y, Ding L, Wang Z, Pei R, Yan J, Wu C, Li X, Jia H, Zhang L, Zhang M, Wang J, Wang J. Exposure to polycyclic aromatic hydrocarbons promotes the progression of low-grade cervical intraepithelial neoplasia: A population-based cohort study in China. Int J Cancer 2024. [PMID: 38733360 DOI: 10.1002/ijc.34990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Low-grade cervical intraepithelial neoplasia (CIN1) is an early stage of cervical cancer development. Previously, we reported that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of cervical precancerous lesions, especially in females with a high-risk human papillomavirus (HR-HPV) infection. However, the effects of PAHs on CIN1 progression remain unclear. A community-based prospective cohort study was conducted to evaluate the role of exposure to PAHs in the progression of CIN1. A total of 564 patients diagnosed with CIN1 were followed-up at 6, 12, and 24 months, post-diagnosis, to determine CIN1 reversion, persistence, and progression. Exposure to PAHs was determined by the urine 1-hydroxipayrene (1-OHP) level. Our results showed that the 1-OHP level was significantly higher in patients with CIN1 persistence/progression than in those with reversion (P < .05). High exposure to PAHs increased the risk of CIN1 persistence/progression, with hazard ratios (HR), 95% confidence intervals (CI) of (1.62, 1.24-2.67), (1.98, 1.42-2.75), and (2.37, 1.61-3.49) at 6, 12, and 24 months, post-diagnosis, respectively. The effect was enhanced with HR-HPV positivity, as determined at 6 (1.82, 1.24-2.67), 12 (3.02, 1.74-5.23), and 24 (2.51, 1.48-4.26) months, post-diagnosis. Moreover, the predictive value of exposure to PAHs for CIN1 persistence/progression was higher in HR-HPV-positive patients than in HR-HPV-negative patients. The results revealed that exposure to PAHs facilitated the malignant progression of CIN1 and hindered its reversal, particularly in patients with HR-HPV infection. Our findings provide novel insights into early prevention and intervention targeting the initiation and progression of cervical neoplasia.
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Affiliation(s)
- Meng Cui
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Li Song
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Rui Mao
- Questrom School of Business, Boston University, Boston, Massachusetts, USA
| | - Yuanjing Lyu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Ling Ding
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhilian Wang
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruixin Pei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jiaxin Yan
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Caihong Wu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoxue Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haixia Jia
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
- Shanxi Cancer Hospital, Taiyuan, China
| | - Le Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Mingxuan Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jiahao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jintao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
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Lin X, Zheng W, Zhao X, Zeng M, Li S, Peng S, Song T, Sun Y. Microbiome in gynecologic malignancies: a bibliometric analysis from 2012 to 2022. Transl Cancer Res 2024; 13:1980-1996. [PMID: 38737701 PMCID: PMC11082697 DOI: 10.21037/tcr-23-1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/29/2024] [Indexed: 05/14/2024]
Abstract
Microbiome and microbial dysbiosis have been proven to be involved in the carcinogenesis and treatment of gynecologic malignancies. However, there is a noticeable gap in the literature, as no comprehensive papers have covered general information, research status, and research frontiers in this field. This study addressed this gap by exploring the relationship between the gut and female reproductive tract (FRT) microbiome and gynecological cancers from a bibliometric perspective. Using VOSviewer 1.6.18, CiteSpace 6.1.R6, and HistCite Pro 2.1 software, we analyzed data retrieved from the Web of Science (WOS) Core Collection (WoSCC) database. Our dataset, consisting of 204 articles published from 2012 to 2022, revealed a consistent and upward publication trend. The United States and the United Kingdom were the primary driving forces, attributed to their prolificacy, high-quality output, and extensive cooperation. The University of Arizona Cancer Center, which is affiliated with the United States, ranked first among the top ten most prolific institutions. Frontiers in Cellular and Infection Microbiology emerged as the leading publisher. Herbst-Kralovetz MM led as the most productive author. Mitra A was the most influential author. Cervical cancer is notably associated with the microbiome, while endometrial and ovarian cancers are receiving increased attention in the last year. Intersections between the gut microbiome and estrogen are of growing importance. Current research focuses on identifying specific microbial species for etiological diagnosis, while frontiers mainly focus on the anticancer potential of microorganisms, such as regulating the effects of immune checkpoint inhibitors. In conclusion, this study sheds light on a novel and burgeoning direction of research, providing a one-stop overview of the microbiome in gynecologic malignancies. Its findings aim to help young researchers to identify research directions and future trends for ongoing investigations.
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Affiliation(s)
- Xiaowen Lin
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weiqin Zheng
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaotong Zhao
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mengyao Zeng
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shibo Li
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sizheng Peng
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tao Song
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhui Sun
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Zeber-Lubecka N, Kulecka M, Dabrowska M, Baginska-Drabiuk K, Glowienka-Stodolak M, Nowakowski A, Slabuszewska-Jozwiak A, Bednorz B, Jędrzejewska I, Piasecka M, Pawelec J, Wojciechowska-Lampka E, Ostrowski J. Cervical microbiota dysbiosis associated with high-risk Human Papillomavirus infection. PLoS One 2024; 19:e0302270. [PMID: 38669258 PMCID: PMC11051640 DOI: 10.1371/journal.pone.0302270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
High-risk Human Papillomavirus (HR-HPV) genotypes, specifically HPV16 and HPV18, pose a significant risk for the development of cervical intraepithelial neoplasia and cervical cancer. In the multifaceted cervical microenvironment, consisting of immune cells and diverse microbiota, Lactobacillus emerges as a pivotal factor, wielding significant influence in both stabilizing and disrupting the microbiome of the reproductive tract. To analyze the distinction between the cervical microbiota and Lactobacillus-dominant/non-dominant status of HR-HPV and non-infected healthy women, sixty-nine cervical swab samples were analyzed, included 44 with HR-HPV infection and healthy controls. All samples were recruited from Human Papillomavirus-based cervical cancer screening program and subjected to 16s rRNA sequencing analysis. Alpha and beta diversity analyses reveal no significant differences in the cervical microbiota of HR-HPV-infected women, including 16 and 18 HPV genotypes, and those with squamous intraepithelial lesion (SIL), compared to a control group. In this study we identified significantly lower abundance of Lactobacillus mucosae in women with HR-HPV infection compared to the control group. Furthermore, changes in bacterial diversity were noted in Lactobacillus non-dominant (LND) samples compared to Lactobacillus-dominant (LD) in both HR-HPV-infected and control groups. LND samples in HR-HPV-infected women exhibited a cervical dysbiotic state, characterized by Lactobacillus deficiency. In turn, the LD HR-HPV group showed an overrepresentation of Lactobacillus helveticus. In summary, our study highlighted the distinctive roles of L. mucosae and L. helveticus in HR-HPV infections, signaling a need for further research to demonstrate potential clinical implications of cervical microbiota dysbiosis.
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Affiliation(s)
- Natalia Zeber-Lubecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Kulecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michalina Dabrowska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Maria Glowienka-Stodolak
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Nowakowski
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Bożena Bednorz
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ilona Jędrzejewska
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Piasecka
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jolanta Pawelec
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jerzy Ostrowski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Qulu W, Mtshali A, Osman F, Ndlela N, Ntuli L, Mzobe G, Naicker N, Garrett N, Rompalo A, Mindel A, Ngcapu S, Liebenberg L. High-risk human papillomavirus prevalence among South African women diagnosed with other STIs and BV. PLoS One 2023; 18:e0294698. [PMID: 38032961 PMCID: PMC10688634 DOI: 10.1371/journal.pone.0294698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) infection is a leading cause of cervical cancer. Although this relies on infection and persistence of HPV in epithelial cells, often occurring in the context of other sexually transmitted infections (STIs) and bacterial vaginosis (BV), data on the relationships between these and their relative effects on epithelial barrier integrity in women remain sparse. This study describes the epidemiology of HPV combined with STI and/or BV prevalence and the relative impact on matrix metalloproteinases (MMPs) among South African women. METHODS Roche Linear Array was used for HPV genotyping in menstrual cup pellets of 243 HIV-negative women participating in the CAPRISA 083 cohort study. Vulvovaginal swabs were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using Xpert® CT/NG assay and lateral flow assay, and Gram staining was performed to diagnose BV using Nugent scoring criteria. Concentrations of 5 MMPs were measured in menstrual cup supernatants by multiplexed ELISA. Fisher's exact tests, Mann-Whitney U tests, and multivariable regression models determined associations between HPV infection, STI and/or BV, and MMP concentrations. RESULTS HPV was prevalent in 34% of women (83/243; median 23 years, interquartile range (IQR) 21-27 years). Low-risk (lr) (71%, 59/83) and high-risk (hr)-HPV infections (54.2%, 45/83) were common. Hr-HPV was frequently detected in STI and/or BV-positive women compared to women without STIs or BV (p = 0.029). In multivariable analysis, BV was associated with increased odds of hr-HPV detection (OR: 2.64, 95%CI: 1.02-6.87, p = 0.046). Furthermore, Gardasil®9 vaccine-type strains were more frequently detected in women diagnosed with STI and/or BV (55.2%, 32/58 vs 24%, 6/25; p = 0.009). Among STI and/or BV-positive women, HPV detection was significantly associated with increased MMP-10 concentrations (b = 0.55, 95% CI 0.79-1.01; p = 0.022). CONCLUSION Most women with hr-HPV had another STI and/or BV, emphasizing an urgent need for STI and BV screening and intensive scale-up of cervical cancer screening and HPV vaccination programmes. Furthermore, the study highlights the need for more extensive research to confirm and understand the relationship between HPV infection and barrier integrity.
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Affiliation(s)
- Wenkosi Qulu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Mtshali
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Farzana Osman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nonsikelelo Ndlela
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lungelo Ntuli
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Gugulethu Mzobe
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lenine Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation, Stellenbosch University, Cape Town, South Africa
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Molina MA, Melchers WJ, Andralojc KM, Leenders WP, Huynen MA. Longitudinal analysis on the ecological dynamics of the cervicovaginal microbiome in hrHPV infection. Comput Struct Biotechnol J 2023; 21:4424-4431. [PMID: 37731597 PMCID: PMC10507478 DOI: 10.1016/j.csbj.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Abstract
The cervicovaginal microbiome (CVM) is a dynamic continuous microenvironment that can be clustered in microbial community state types (CSTs) and is associated with women's cervical health. Lactobacillus-depleted communities particularly associate with an increased susceptibility for persistence of high-risk human papillomavirus (hrHPV) infections and progression of disease, but the long-term ecological dynamics of CSTs after hrHPV infection diagnosis remain poorly understood. To determine such dynamics, we examined the CVM of our longitudinal cohort of 141 women diagnosed with hrHPV infection at baseline with collected cervical smears at two timepoints six-months apart. Here we describe that the long-term microbiome dissimilarity has a positive correlation with microbial diversity at both visits and that women with high abundance and dominance for Lactobacillus iners at baseline exhibit more similar microbiome composition at second visit than women with Lactobacillus-depleted communities at baseline. We further show that the species Lactobacillus acidophilus and Megasphaera genomosp type 1 associate with CST changes between both visits. Lastly, we also observe that Gardnerella vaginalis is associated with the stability of Lactobacillus-depleted communities while L. iners is associated with the instability of Megasphaera genomosp type 1-dominated communities. Our data suggest dynamic patterns of cervicovaginal CSTs during hrHPV infection, which could be potentially used to develop microbiome-based therapies against infection progression towards disease.
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Affiliation(s)
- Mariano A. Molina
- Department of Medical Microbiology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Willem J.G. Melchers
- Department of Medical Microbiology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
| | - Karolina M. Andralojc
- Department of Medical Microbiology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
| | | | - Martijn A. Huynen
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, 6525 GA, Nijmegen, the Netherlands
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Gao Q, Fan T, Luo S, Zheng J, Zhang L, Cao L, Zhang Z, Li L, Huang Z, Zhang H, Huang L, Xiao Q, Qiu F. Lactobacillus gasseri LGV03 isolated from the cervico-vagina of HPV-cleared women modulates epithelial innate immune responses and suppresses the growth of HPV-positive human cervical cancer cells. Transl Oncol 2023; 35:101714. [PMID: 37331103 PMCID: PMC10366645 DOI: 10.1016/j.tranon.2023.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/24/2022] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
Persistent human papillomavirus (HPV) infections is necessary for the development of cervical cancers. An increasing number of retrospective studies have found the depletion of Lactobacillus microbiota in the cervico-vagina facilitate HPV infection and might be involved in viral persistence and cancer development. However, there have been no reports confirming the immunomodulatory effects of Lactobacillus microbiota isolated from cervico-vaginal samples of HPV clearance in women. Using cervico-vaginal samples from HPV persistent infection and clearance in women, this study investigated the local immune properties in cervical mucosa. As expected, type I interferons, such as IFN-α and IFN-β, and TLR3 globally downregulated in HPV+ persistence group. Luminex cytokine/chemokine panel analysis revealed that L. jannaschii LJV03, L. vaginalis LVV03, L. reuteri LRV03, and L. gasseri LGV03 isolated from cervicovaginal samples of HPV clearance in women altered the host's epithelial immune response, particularly L. gasseri LGV03. Furthermore, L. gasseri LGV03 enhanced the poly (I:C)-induced production of IFN by modulating the IRF3 pathway and attenuating poly (I:C)-induced production of proinflammatory mediators by regulating the NF-κB pathway in Ect1/E6E7 cells, indicating that L. gasseri LGV03 keeps the innate system alert to potential pathogens and reduces the inflammatory effects during persistent pathogen infection. L. gasseri LGV03 also markedly inhibited the proliferation of Ect1/E6E7 cells in a zebrafish xenograft model, which may be attributed to an increased immune response mediated by L. gasseri LGV03.
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Affiliation(s)
- Qiong Gao
- Department of Gynecology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Tao Fan
- Department of Obstetrics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518003, China
| | - Siying Luo
- Department of Gynecology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Jieting Zheng
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Lin Zhang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Longbing Cao
- Department of Laboratory Medicine, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong 528244, China
| | - Zikang Zhang
- Department of Laboratory Medicine, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong 528244, China
| | - Li Li
- Department of Gynecology, University of Chinese Academy of Sciences Shenzhen Hospital (Guangming), Shenzhen, 518000, China
| | - Zhu Huang
- Department of Gynecology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Huifen Zhang
- Department of Obstetrics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518003, China
| | - Liuxuan Huang
- Department of Gynecology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Qing Xiao
- Department of Gynecology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Feng Qiu
- Department of Laboratory Medicine, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong 528244, China.
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Sun L, Li L, Xu W, Ma C. The Immunomodulation Role of Vaginal Microenvironment On Human Papillomavirus Infection. Galen Med J 2023; 12:1-7. [PMID: 38827643 PMCID: PMC11144026 DOI: 10.31661/gmj.v12i0.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Evidence suggests the role of the vaginal microbiome and microenvironment in the immunity state. The human papillomavirus (HPV) infection is widely dependent on the healthy vaginal microenvironment. Hence, this study aimed to investigate the role of the vaginal microenvironment in the rate of high-risk HPV (hr-HPV) infection. MATERIALS AND METHODS This cross-sectional study was performed on 512 women with hr-HPV positive (n=212) or negative (n=300) infection. The vaginal samples of women were examined regarding yeas and Gardnerella vaginalis infection. Also, Lactobacillus acidophilus, pH, and enzyme activity (such as catalase, proline aminopeptidase, and leucocyte esterase) were compared between the two groups. Also, the histopathological study was performed on the vaginal samples. RESULTS The higher rate of yeast and G. vaginalis infections as well as decreased L. acidophilus, were significantly observed in women with hr-HPV positive infection (P0.001). Also, histopathological findings indicated that cervical intraepithelial neoplasia grade I-III and cervical cancer lesions were markedly higher in hr-HPV positive group compared with control women. CONCLUSION The hr-HPV infection was markedly correlated to vaginal microenvironments, and it could a risk factor for the elevation of the rate of high-grade cervical lesions.
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Affiliation(s)
- Lingyan Sun
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Li Li
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Wenxin Xu
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
| | - Cen Ma
- Department of Obstetrics and Gynecology Laboratory, The First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu 215000, China
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Teka B, Yoshida-Court K, Firdawoke E, Chanyalew Z, Gizaw M, Addissie A, Mihret A, Colbert LE, Napravnik TC, El Alam MB, Lynn EJ, Mezzari M, Anuja J, Kantelhardt EJ, Kaufmann AM, Klopp AH, Abebe T. Cervicovaginal Microbiota Profiles in Precancerous Lesions and Cervical Cancer among Ethiopian Women. Microorganisms 2023; 11:microorganisms11040833. [PMID: 37110255 PMCID: PMC10144031 DOI: 10.3390/microorganisms11040833] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Although high-risk human papillomavirus infection is a well-established risk factor for cervical cancer, other co-factors within the local microenvironment may play an important role in the development of cervical cancer. The current study aimed to characterize the cervicovaginal microbiota in women with premalignant dysplasia or invasive cervical cancer compared with that of healthy women. The study comprised 120 Ethiopian women (60 cervical cancer patients who had not received any treatment, 25 patients with premalignant dysplasia, and 35 healthy women). Cervicovaginal specimens were collected using either an Isohelix DNA buccal swab or an Evalyn brush, and ribosomal RNA sequencing was used to characterize the cervicovaginal microbiota. Shannon and Simpson diversity indices were used to evaluate alpha diversity. Beta diversity was examined using principal coordinate analysis of weighted UniFrac distances. Alpha diversity was significantly higher in patients with cervical cancer than in patients with dysplasia and in healthy women (p < 0.01). Beta diversity was also significantly different in cervical cancer patients compared with the other groups (weighted UniFrac Bray-Curtis, p < 0.01). Microbiota composition differed between the dysplasia and cervical cancer groups. Lactobacillus iners was particularly enriched in patients with cancer, and a high relative abundance of Lactobacillus species was identified in the dysplasia and healthy groups, whereas Porphyromonas, Prevotella, Bacteroides, and Anaerococcus species predominated in the cervical cancer group. In summary, we identified differences in cervicovaginal microbiota diversity, composition, and relative abundance between women with cervical cancer, women with dysplasia, and healthy women. Additional studies need to be carried out in Ethiopia and other regions to control for variation in sample collection.
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Affiliation(s)
- Brhanu Teka
- Department of Microbiology, Immunology and Parasitology School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
- Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, 06097 Halle, Germany
- Correspondence: ; Tel.: +251-913500065
| | - Kyoko Yoshida-Court
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ededia Firdawoke
- Department of Microbiology, Immunology and Parasitology School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Zewditu Chanyalew
- Department of Pathology, St. Paul Hospital Millennium Medical College, Addis Ababa P.O. Box 1271, Ethiopia
| | - Muluken Gizaw
- Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, 06097 Halle, Germany
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 34, Ethiopia
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, 06120 Halle, Germany
- NCD Working Group, Addis Ababa University, Addis Ababa P.O. Box 34, Ethiopia
| | - Adamu Addissie
- Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, 06097 Halle, Germany
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 34, Ethiopia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa P.O. Box 1005, Ethiopia
| | - Lauren E. Colbert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tatiana Cisneros Napravnik
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Molly B. El Alam
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Erica J. Lynn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Melissa Mezzari
- Molecular Virology and Microbiology, Baylor College of Medicine Alkek, Center for Molecular Discovery, Houston, TX 77030, USA
| | - Jhingran Anuja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, 06097 Halle, Germany
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, 06120 Halle, Germany
| | - Andreas M. Kaufmann
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Ann H. Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
- Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, 06097 Halle, Germany
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9
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Celiac Disease Predisposition and Genital Tract Microbiota in Women Affected by Recurrent Pregnancy Loss. Nutrients 2023; 15:nu15010221. [PMID: 36615877 PMCID: PMC9823693 DOI: 10.3390/nu15010221] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
The incidence of Idiopathic Recurrent Pregnancy Loss (RPL) is doubled in patients suffering from Celiac Disease (CD) compared to healthy populations. CD genetic components are HLA class II genes known as HLA-DQ2 and DQ8. Genetically susceptible women can remain asymptomatic even though they are exposed to a doubled risk of RPL compared to the general population. Furthermore, CD has been associated with microbiota alterations. The aim of this study is to evaluate endometrial and vaginal microbiota in HLA-DQ2/DQ8 positive and negative RPL patients compared to healthy pregnant women. Endometrial and vaginal microbiota of 3 subgroups were evaluated: 15 HLA-DQ2/DQ8 positive RPL women, 25 HLA DQ2/DQ8 negative RPL women (for a total of 40 RPL women) and 7 healthy fertile controls with previous uncomplicated pregnancies (all HLA-DQ2/DQ8 negative). The 2 RPL subgroups (HLA-DQ2/DQ8 positive and negative) showed a different endometrial and vaginal composition in the Lactobacillacae family compared to controls: Lactobacillus acidophilus was absent both in the vaginal and endometrial samples of RPL women, while Lactobaciluus iners, which can favor a less stable vaginal microbiota, was found only in RPL women (26.4% in HLA DQ2/DQ8 positive and 22.1% HLA DQ2/DQ8 negative) in both the vaginal and endometrial districts. In conclusion, both HLA DQ2/DQ8 positive-RPL and HLA DQ2/DQ8 negative-RPL women showed different endometrial and vaginal microbiota composition compared to healthy controls.
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10
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Jansåker F, Li X, Sundqvist A, Sundquist K, Borgfeldt C. Cervical neoplasia in relation to socioeconomic and demographic factors - a nationwide cohort study (2002-2018). Acta Obstet Gynecol Scand 2022; 102:114-121. [PMID: 36330802 PMCID: PMC9780723 DOI: 10.1111/aogs.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Cervical cancer is a major cause of mortality and morbidity. We aimed to estimate the association between sociodemographic factors and cervical neoplasia. MATERIAL AND METHODS In this Swedish nationwide open cohort study, 4 120 557 women aged ≥15 years at baseline were included between January 1, 2002 and December 31, 2018. The two outcomes were cervical cancer and carcinoma in situ identified in the Swedish Cancer Register. Sociodemographic factors (age, education level, family income level, region of residency, country of origin) were the main predictors. Incidence rates per 10 000 person-years were calculated. Cox regression was used to estimate hazard ratios. Sensitivity analyses were conducted, including parity, urogenital infections, alcohol- and drug-use disorders, and chronic obstructive pulmonary disease (used as a proxy for tobacco abuse). RESULTS In 38.9 million person-years of follow-up, 5781 (incidence rate: 1.5, 95% confidence interval [CI] 1.4-1.5) and 62 249 (incidence rate 16.9, 95% CI 15.9-16.1) women were diagnosed with cervical cancer and carcinoma in situ, respectively. Women from Eastern Europe had a hazard ratio of 1.18 (95% CI 1.05-1.33) for cervical cancer compared with Swedish-born women, while women from non-Western regions were inversely associated with cervical cancer and carcinoma in situ. Women with a low education level had a hazard ratio of 1.37 (95% CI 1.29-1.45) for cervical cancer compared with women with a high education level. CONCLUSIONS Women from the Middle East and Africa living in Sweden seem to suffer less from cervical neoplasia, whereas women with low education and women from Eastern Europe seem to suffer more from cervical cancer.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences MalmöLund UniversityLundSweden,Department of Clinical MicrobiologyRigshospitaletCopenhagenDenmark
| | - Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences MalmöLund UniversityLundSweden
| | - Avalon Sundqvist
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences MalmöLund UniversityLundSweden,Center for Community‐based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of MedicineShimane UniversityShimaneJapan,Department of Family Medicine and Community Health, Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
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11
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Adebamowo SN, Befano B, Cheung LC, Rodriguez AC, Demarco M, Rydzak G, Chen X, Porras C, Herrero R, Kim JJ, Castle PE, Wentzensen N, Kreimer AR, Schiffman M, Campos NG. Different human papillomavirus types share early natural history transitions in immunocompetent women. Int J Cancer 2022; 151:920-929. [PMID: 35603904 PMCID: PMC9329241 DOI: 10.1002/ijc.34128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/07/2022]
Abstract
Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS-LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high-grade cervical abnormalities at any point during follow-up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval-censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18-29, 30-44 and 45-54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost-effectiveness of novel prevention technologies.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center; University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Greg Rydzak
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Jane J. Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicole G. Campos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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12
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BV associated bacteria specifically BVAB 1 and BVAB 3 as biomarkers for HPV risk and progression of cervical neoplasia. Infect Dis Obstet Gynecol 2022; 2022:9562937. [PMID: 35996693 PMCID: PMC9392619 DOI: 10.1155/2022/9562937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Bacterial vaginosis (BV) is associated with high-risk HPV (hrHPV) genotypes. There is a proposed bidirectional relationship between hrHPV and vaginal microbial diversity. This study investigated the association between BV associated bacteria in women co-infected with Human immunodeficiency virus (HIV) and hrHPV. Methods Stored cervical cytobrush samples were used for real time PCR detection of eight BV associated bacteria. Analysis of BV bacteria detected against HPV infection, socio-demographics and HIV data were conducted in R Statistical computing software of the R Core Team, 2020, version 3.6.3. Results A total of 190 samples were analysed. A. vaginae (p <0.001) BVAB 1 (p <0.001), BVAB 2 (p =0.428), BVAB 3 (p <0.001), Lactobacillus species (p =0.016) and S. sanguinegens (p =0.007) were associated with prevalent hrHPV. Increasing CIN severity was independently associated with detection of BVAB 1 OR 1.51(95% CI: 0.42-5.55), BVAB 3 OR 2.72(95% CI:0.90-8.55) and S. sanguinegens OR 1.02(95% CI:0.37-2.80). All HPV genotypes/groups, gravida <2, A. vaginae (p =0.002) and BVAB 1 (p =0.026) were significantly associated with HPV persistence. BVAB 3, p =0.010 and HPV 16 were significantly associated with HPV reinfection. Conclusion There is a significant association of A. vaginae, BVAB 1, BVAB 3, S. sanguinegens and Lactobacillus spp to prevalent hrHPV. BVAB 1, BVAB 3 and S. sanguinegens had an increased odds for increasing CIN severity. A vaginae, BVAB 1, gravida and all the HPV genotypes/groups were significantly associated with HPV persistence. Only BVAB 3 and HPV 16 were significantly associated with hrHPV reinfection at 1 year review. BVAB 1 and BVAB 3 are possible biomarkers for HPV infection and CIN progression.
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13
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Guo C, Dai W, Zhou Q, Gui L, Cai H, Wu D, Hou J, Li C, Li S, Du H, Wu R. Cervicovaginal microbiota significantly changed for HPV-positive women with high-grade squamous intraepithelial lesion. Front Cell Infect Microbiol 2022; 12:973875. [PMID: 35992171 PMCID: PMC9386141 DOI: 10.3389/fcimb.2022.973875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Lower female genital tract is colonized by a variety of microbes (cervicovaginal microbiota, CVM) which associate with the risk of genital infection. This study characterized CVM for 149 Chinese women with different status of human papillomavirus (HPV) infection and squamous intraepithelial lesion (SIL): no HPV infection (HPV-), HPV infection without significant SIL (HPV+NoSIL), HPV infection with low-grade SIL (HPV+LSIL) and HPV infection with high-grade SIL (HPV+HSIL). Analysis results showed CVM has dramatically changed in HPV+HSIL group when compared to HPV+LSIL group, but it exhibited no significant differences between HPV- and HPV+NoSIL groups as well as between HPV+NoSIL and HPV+LSIL groups. In consistence, random forest analysis found more notable differences in HPV+HSIL vs HPV+LSIL comparison than in other comparisons. In addition, depletion of Lactobacillus in CVM was more to be frequently identified in SIL-positive women as compared to SIL-negative individuals. Our findings suggested that significant CVM differences occurred when SIL developed to HSIL which was caused by persistent HPV infection.
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Affiliation(s)
- Chunlei Guo
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Wenkui Dai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Qian Zhou
- Department of Computer Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Liming Gui
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Han Cai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Di Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Hou
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Shuaicheng Li
- Department of Computer Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
- *Correspondence: Ruifang Wu, ; Hui Du,
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center (PKU-HKUST) Medical Center, Shenzhen, China
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
- *Correspondence: Ruifang Wu, ; Hui Du,
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14
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Anton L, Ferguson B, Friedman ES, Gerson KD, Brown AG, Elovitz MA. Gardnerella vaginalis alters cervicovaginal epithelial cell function through microbe-specific immune responses. MICROBIOME 2022; 10:119. [PMID: 35922830 PMCID: PMC9351251 DOI: 10.1186/s40168-022-01317-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/26/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND The cervicovaginal (CV) microbiome is highly associated with vaginal health and disease in both pregnant and nonpregnant individuals. An overabundance of Gardnerella vaginalis (G. vaginalis) in the CV space is commonly associated with adverse reproductive outcomes including bacterial vaginosis (BV), sexually transmitted diseases, and preterm birth, while the presence of Lactobacillus spp. is often associated with reproductive health. While host-microbial interactions are hypothesized to contribute to CV health and disease, the mechanisms by which these interactions regulate CV epithelial function remain largely unknown. RESULTS Using an in vitro co-culture model, we assessed the effects of Lactobacillus crispatus (L. crispatus) and G. vaginalis on the CV epithelial barrier, the immune mediators that could be contributing to decreased barrier integrity and the immune signaling pathways regulating the immune response. G. vaginalis, but not L. crispatus, significantly increased epithelial cell death and decreased epithelial barrier integrity in an epithelial cell-specific manner. A G. vaginalis-mediated epithelial immune response including NF-κB activation and proinflammatory cytokine release was initiated partially through TLR2-dependent signaling pathways. Additionally, investigation of the cytokine immune profile in human CV fluid showed distinctive clustering of cytokines by Gardnerella spp. abundance and birth outcome. CONCLUSIONS The results of this study show microbe-specific effects on CV epithelial function. Altered epithelial barrier function through cell death and immune-mediated mechanisms by G. vaginalis, but not L. crispatus, indicates that host epithelial cells respond to bacteria-associated signals, resulting in altered epithelial function and ultimately CV disease. Additionally, distinct immune signatures associated with Gardnerella spp. or birth outcome provide further evidence that host-microbial interactions may contribute significantly to the biological mechanisms regulating reproductive outcomes. Video Abstract.
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Affiliation(s)
- Lauren Anton
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Briana Ferguson
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elliot S Friedman
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kristin D Gerson
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Microbiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Amy G Brown
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michal A Elovitz
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Microbiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
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15
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Jansåker F, Li X, Knudsen JD, Frimodt-Møller N, Borgfeldt C, Sundquist K. The association between common urogenital infections and cervical neoplasia - A nationwide cohort study of over four million women (2002-2018). THE LANCET REGIONAL HEALTH. EUROPE 2022; 17:100378. [PMID: 35494213 PMCID: PMC9039866 DOI: 10.1016/j.lanepe.2022.100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cervical cancer is a major cause of mortality and morbidity in women worldwide. This study aimed to estimate the association between common urogenital infections and cervical neoplasia. METHODS A multi-register national cohort study of 4,120,557 women aged ≥15 years (2002-2018) was conducted. The outcomes were cervical cancer and carcinoma in situ (Swedish Cancer Register). The main predictors were urogenital infections-(urinary) cystitis, (bacterial) vaginosis, (candida) vulvovaginitis. Incidence rates per 10,000 person-years were calculated (using the European Standard Population). Cox regression was used to estimate hazard ratios (HR) while adjusting for possible confounders-other genital infections (e.g., cervicitis, salpingitis, urogenital herpes), parity, and sociodemographic factors. FINDINGS In 39·0 million person-years of follow-up, the incidence rate for cervical cancer was 1·2 (95% CI 1·1-1·2) per 10,000 person-years and the figure for cervical carcinoma in situ was more than tenfold higher. The fully adjusted HRs for cervical cancer were 1·31 (95% CI 1·15 and 1·48) and 1·22 (95% CI 1·16 and 1·29) for vaginosis and cystitis, respectively. Vaginosis showed a gradient association to carcinoma in situ. Vulvovaginitis was inversely associated with cervical cancer, but not significantly related with carcinoma in situ in the fully adjusted model. A temporal association with cervical cancer was observed for vaginosis and vulvovaginitis (inversely) but not for cystitis. INTERPRETATION In this large nationwide cohort of women, medically attended common urogenital infections were independently associated with cervical neoplasia, but cystitis was not temporally associated with cervical neoplasia. These findings could be used to increase focus on preventive measures, HPV-vaccination programmes, HPV-analyses- and cervical cancer screening, especially in women suffering from vaginosis. Future studies on the causal mechanism are warranted before generalized public health recommendations can be made. FUNDING Region Skåne, Tore Nilsons Stiftelse, and Swedish Society of Medicine.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Jan Waldenströms gata 35, Malmö 205 02, Sweden
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Xinjun Li
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Jan Waldenströms gata 35, Malmö 205 02, Sweden
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Christer Borgfeldt
- Department of Obstetrics and Gynaecology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Jan Waldenströms gata 35, Malmö 205 02, Sweden
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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16
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Sundquist K, Li X, Jansåker F. Sociodemographic factors and uncomplicated pyelonephritis in women aged 15-50 years: a nationwide Swedish cohort register study (1997-2018). Int J Infect Dis 2021; 111:117-123. [PMID: 34384898 DOI: 10.1016/j.ijid.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To study the relationship between sociodemographic factors and pyelonephritis. METHODS A nationwide open cohort study consisting of 2 052 873 women (76.2% Swedish-born) aged 15-50 years was conducted (1997-2018). The outcome was first event of acute uncomplicated pyelonephritis diagnosed in primary health care settings in relation to the sociodemographic factors. Cox regression models were used in the analyses. RESULTS The study identified 40 724 cases. In the fully adjusted model, women from non-western countries had higher risks of pyelonephritis compared to Swedish-born women. Women from Latin America/Caribbean had highest risk (Hazard ratio = 1.60; 95% CI 1.49-1.72), followed by Eastern Europe (HR = 1.26; 95% CI 1.21-1.32) and Middle East/North Africa (HR = 1.25; 95% CI 1.19-1.30). Low education, low income, urban living, and young age were also associated with higher risks of pyelonephritis. CONCLUSION This study presents novel risk factors associated with pyelonephritis. Women from non-western countries and with low socioeconomic status might suffer disproportionately from this serious infection. This might be due to biological predispositions and the fact that immigrant women do not acquire the same level of health or might receive less health care compared to native women, even in the presence of universal health care.
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Affiliation(s)
- Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden.
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17
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Dai W, Du H, Li S, Wu R. Cervicovaginal Microbiome Factors in Clearance of Human Papillomavirus Infection. Front Oncol 2021; 11:722639. [PMID: 34395294 PMCID: PMC8355615 DOI: 10.3389/fonc.2021.722639] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 01/13/2023] Open
Abstract
Persistent high-risk human papillomavirus (hrHPV) infection is the highest risk to cervical cancer which is the fourth most common cancer in women worldwide. A growing body of literatures demonstrate the role of cervicovaginal microbiome (CVM) in hrHPV susceptibility and clearance, suggesting the promise of CVM-targeted interventions in protecting against or eliminating HPV infection. Nevertheless, the CVM-HPV-host interactions are largely unknown. In this review, we summarize imbalanced CVM in HPV-positive women, with or without cervical diseases, and the progress of exploring CVM resources in HPV clearance. In addition, microbe- and host-microbe interactions in HPV infection and elimination are reviewed to understand the role of CVM in remission of HPV infection. Lastly, the feasibility of CVM-modulated and -derived products in promoting HPV clearance is discussed. Information in this article will provide valuable reference for researchers interested in cervical cancer prevention and therapy.
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Affiliation(s)
- Wenkui Dai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China.,Institute of Obstetrics and Gynecology, Shenzhen Peking University-The Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China.,Institute of Obstetrics and Gynecology, Shenzhen Peking University-The Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Shuaicheng Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China.,Institute of Obstetrics and Gynecology, Shenzhen Peking University-The Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
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18
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The correlation between vaginal microecological dysbiosis-related diseases and preterm birth: A review. MEDICINE IN MICROECOLOGY 2021. [DOI: 10.1016/j.medmic.2021.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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