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Hugerth LW, Krog MC, Vomstein K, Du J, Bashir Z, Kaldhusdal V, Fransson E, Engstrand L, Nielsen HS, Schuppe-Koistinen I. Defining Vaginal Community Dynamics: daily microbiome transitions, the role of menstruation, bacteriophages, and bacterial genes. MICROBIOME 2024; 12:153. [PMID: 39160615 PMCID: PMC11331738 DOI: 10.1186/s40168-024-01870-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/09/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND The composition of the vaginal microbiota during the menstrual cycle is dynamic, with some women remaining eu- or dysbiotic and others transitioning between these states. What defines these dynamics, and whether these differences are microbiome-intrinsic or mostly driven by the host is unknown. To address this, we characterized 49 healthy, young women by metagenomic sequencing of daily vaginal swabs during a menstrual cycle. We classified the dynamics of the vaginal microbiome and assessed the impact of host behavior as well as microbiome differences at the species, strain, gene, and phage levels. RESULTS Based on the daily shifts in community state types (CSTs) during a menstrual cycle, the vaginal microbiome was classified into four Vaginal Community Dynamics (VCDs) and reported in a classification tool, named VALODY: constant eubiotic, constant dysbiotic, menses-related, and unstable dysbiotic. The abundance of bacteria, phages, and bacterial gene content was compared between the four VCDs. Women with different VCDs showed significant differences in relative phage abundance and bacterial composition even when assigned to the same CST. Women with unstable VCDs had higher phage counts and were more likely dominated by L. iners. Their Gardnerella spp. strains were also more likely to harbor bacteriocin-coding genes. CONCLUSIONS The VCDs present a novel time series classification that highlights the complexity of varying degrees of vaginal dysbiosis. Knowing the differences in phage gene abundances and the genomic strains present allows a deeper understanding of the initiation and maintenance of permanent dysbiosis. Applying the VCDs to further characterize the different types of microbiome dynamics qualifies the investigation of disease and enables comparisons at individual and population levels. Based on our data, to be able to classify a dysbiotic sample into the accurate VCD, clinicians would need two to three mid-cycle samples and two samples during menses. In the future, it will be important to address whether transient VCDs pose a similar risk profile to persistent dysbiosis with similar clinical outcomes. This framework may aid interdisciplinary translational teams in deciphering the role of the vaginal microbiome in women's health and reproduction. Video Abstract.
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Affiliation(s)
- Luisa W Hugerth
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, 75237, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology (MTC), Centre for Translational Microbiome Research, Karolinska Institutet, Nobels Väg 6, 17177, Stockholm, Sweden
| | - Maria Christine Krog
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Blegdamsvej 9, 2100 Copenhagen and Kettegård Alle 30, 2650, Hvidovre, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Kilian Vomstein
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Blegdamsvej 9, 2100 Copenhagen and Kettegård Alle 30, 2650, Hvidovre, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Juan Du
- Department of Microbiology, Tumor and Cell Biology (MTC), Centre for Translational Microbiome Research, Karolinska Institutet, Nobels Väg 6, 17177, Stockholm, Sweden
| | - Zahra Bashir
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Blegdamsvej 9, 2100 Copenhagen and Kettegård Alle 30, 2650, Hvidovre, Denmark
- Department of Obstetrics and Gynecology, Region Zealand, Slagelse Hospital, Fælledvej 13, 4200, Slagelse, Denmark
| | - Vilde Kaldhusdal
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Center for Molecular Medicine, Stockholm, Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology (MTC), Centre for Translational Microbiome Research, Karolinska Institutet, Nobels Väg 6, 17177, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds Vägäg 20, 75185, Uppsala, Sweden
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology (MTC), Centre for Translational Microbiome Research, Karolinska Institutet, Nobels Väg 6, 17177, Stockholm, Sweden
| | - Henriette Svarre Nielsen
- The Recurrent Pregnancy Loss Unit, The Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Blegdamsvej 9, 2100 Copenhagen and Kettegård Alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, Copenhagen University, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Ina Schuppe-Koistinen
- Department of Microbiology, Tumor and Cell Biology (MTC), Centre for Translational Microbiome Research, Karolinska Institutet, Nobels Väg 6, 17177, Stockholm, Sweden
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Krog MC, Nielsen JR, Slot A, Hviid KV, Kolte AM, Westergaard D, Bliddal S, Almstrup K, Nielsen HS. Prospective reproductive outcomes according to sperm parameters, including DNA fragmentation, in recurrent pregnancy loss. Reprod Biomed Online 2024; 49:103773. [PMID: 38879918 DOI: 10.1016/j.rbmo.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 06/18/2024]
Abstract
RESEARCH QUESTION Are the prospective reproductive outcomes in couples experiencing recurrent pregnancy loss (RPL) related to the sperm DNA fragmentation index (DFI), as measured by sperm chromatin structure assay, sperm morphology and sperm concentration at referral? DESIGN This prospective cohort study included 95 couples seen between 1 April 2018 and 1 December 2019 at the tertiary Copenhagen RPL Unit, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Denmark. The couples had experienced three or more unexplained consecutive pregnancy losses or two late pregnancy losses (>12 weeks gestation). Follow-up was 12-31 months. RESULTS Eighty-one of 95 (85.3%) couples achieved pregnancy after referral. In the first pregnancy after referral, 46 (56.8%) couples achieved a live birth, and 35 (43.2%) couples experienced another pregnancy loss. There was no significant difference in baseline DFI between couples that experienced pregnancy loss [median 11.7, interquartile range (IQR) 9.1-17.3] and couples that achieved a live birth (median 12.5, IQR 9.3-16.5; P = 0.971). Improving sperm morphology increased the odds of a live birth after referral (adjusted OR 1.26, 95% CI 1.05-1.52; P = 0.014). DFI and sperm concentration were not associated with the outcome of the first pregnancy after referral. Overall, 35.9% of the men had DFI ≥15 at inclusion. Couples that failed to achieve pregnancy had a higher median DFI of 17.7 (IQR 7.7-27.2) compared with the rest of the cohort (median 12.0, IQR 9.3-16.5; P = 0.041). CONCLUSIONS At referral, sperm DFI, morphology and concentration cannot be used to identify RPL couples at risk of another pregnancy loss. Increased baseline DFI was associated with difficulty achieving another pregnancy, and improving sperm morphology was associated with increased odds of a live birth.
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Affiliation(s)
- Maria Christine Krog
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Josefine Reinhardt Nielsen
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark
| | - Anna Slot
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark
| | - Kathrine Vauvert Hviid
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark
| | - Astrid Marie Kolte
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David Westergaard
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark
| | - Sofie Bliddal
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark; Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Almstrup
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Recurrent Pregnancy Loss Unit, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Copenhagen and Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Hvidovre Hospital, Hvidovre, Denmark
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Bashir Z, Hugerth LW, Krog MC, Prast-Nielsen S, Edfeldt G, Boulund F, Schacht SR, Tetens I, Engstrand L, Schuppe-Koistinen I, Fransson E, Nielsen HS. Investigations of microbiota composition and neuroactive pathways in association with symptoms of stress and depression in a cohort of healthy women. Front Cell Infect Microbiol 2024; 14:1324794. [PMID: 39015337 PMCID: PMC11249552 DOI: 10.3389/fcimb.2024.1324794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/07/2024] [Indexed: 07/18/2024] Open
Abstract
Background Despite mounting evidence of gut-brain involvement in psychiatric conditions, functional data remain limited, and analyses of other microbial niches, such as the vaginal microbiota, are lacking in relation to mental health. This aim of this study was to investigate if the connections between the gut microbiome and mental health observed in populations with a clinical diagnosis of mental illness extend to healthy women experiencing stress and depressive symptoms. Additionally, this study examined the functional pathways of the gut microbiota according to the levels of psychological symptoms. Furthermore, the study aimed to explore potential correlations between the vaginal microbiome and mental health parameters in young women without psychiatric diagnoses. Methods In this cross-sectional study, 160 healthy Danish women (aged 18-40 years) filled out questionnaires with validated scales measuring symptoms of stress and depression and frequency of dietary intake. Fecal and vaginal microbiota samples were collected at the beginning of the menstrual cycle and vaginal samples were also collected at cycle day 8-12 and 18-22. Shotgun metagenomic profiling of the gut and vaginal microbiome was performed. The Kyoto Encyclopedia of Genes and Genomes (KEGG) was used for functional profiling and 56 Gut Brain Modules were analyzed in the fecal samples. Results The relative abundance in the gut of the genera Escherichia, Parabacteroides, and Shigella was higher in women with elevated depressive symptoms. Women with high perceived stress showed a tendency of increased abundance of Escherichia, Shigella, and Blautia. Amongst others, the potentially pathogenic genera, Escherichia and Shigella correlate with alterations in the neuroactive pathways such as the glutamatergic, GABAeric, dopaminergic, and Kynurenine pathways. Vaginosis symptoms were more prevalent in women reporting high levels of stress and depressive symptoms. Conclusions The findings of this study support the concept of a microbiota-associated effect on the neuroactive pathways even in healthy young women. This suggest, that targeting the gut microbiome could be a promising approach for future psychiatric interventions.
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Affiliation(s)
- Zahra Bashir
- Department of Obstetrics and Gynecology, Slagelse Hospital, Slagelse, Denmark
- The Recurrent Pregnancy Loss Unit, Dept. of Fertility, The Capital Region, Copenhagen University Hospitals, Rigshospitalet, Copenhagen, Denmark
- Dept. of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
| | - Luisa W. Hugerth
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Maria Christine Krog
- The Recurrent Pregnancy Loss Unit, Dept. of Fertility, The Capital Region, Copenhagen University Hospitals, Rigshospitalet, Copenhagen, Denmark
- Dept. of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefanie Prast-Nielsen
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Gabriella Edfeldt
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Boulund
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Simon Rønnow Schacht
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Inge Tetens
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Ina Schuppe-Koistinen
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Henriette Svarre Nielsen
- The Recurrent Pregnancy Loss Unit, Dept. of Fertility, The Capital Region, Copenhagen University Hospitals, Rigshospitalet, Copenhagen, Denmark
- Dept. of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Copenhagen, Denmark
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Salas-Espejo E, Terrón-Camero LC, Ruiz JL, Molina NM, Andrés-León E. Exploring the Microbiome in Human Reproductive Tract: High-Throughput Methods for the Taxonomic Characterization of Microorganisms. Semin Reprod Med 2023; 41:125-143. [PMID: 38320576 DOI: 10.1055/s-0044-1779025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Microorganisms are important due to their widespread presence and multifaceted roles across various domains of life, ecology, and industries. In humans, they underlie the proper functioning of multiple systems crucial to well-being, including immunological and metabolic functions. Emerging research addressing the presence and roles of microorganisms within human reproduction is increasingly relevant. Studies implementing new methodologies (e.g., to investigate vaginal, uterine, and semen microenvironments) can now provide relevant insights into fertility, reproductive health, or pregnancy outcomes. In that sense, cutting-edge sequencing techniques, as well as others such as meta-metabolomics, culturomics, and meta-proteomics, are becoming more popular and accessible worldwide, allowing the characterization of microbiomes at unprecedented resolution. However, they frequently involve rather complex laboratory protocols and bioinformatics analyses, for which researchers may lack the required expertise. A suitable pipeline would successfully enable both taxonomic classification and functional profiling of the microbiome, providing easy-to-understand biological interpretations. However, the selection of an appropriate methodology would be crucial, as it directly impacts the reproducibility, accuracy, and quality of the results and observations. This review focuses on the different current microbiome-related techniques in the context of human reproduction, encompassing niches like vagina, endometrium, and seminal fluid. The most standard and reliable methods are 16S rRNA gene sequencing, metagenomics, and meta-transcriptomics, together with complementary approaches including meta-proteomics, meta-metabolomics, and culturomics. Finally, we also offer case examples and general recommendations about the most appropriate methods and workflows and discuss strengths and shortcomings for each technique.
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Affiliation(s)
- Eduardo Salas-Espejo
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Laura C Terrón-Camero
- Bioinformatics Unit, Institute of Parasitology and Biomedicine "López-Neyra" (IPBLN), CSIC, Granada, Spain
| | - José L Ruiz
- Bioinformatics Unit, Institute of Parasitology and Biomedicine "López-Neyra" (IPBLN), CSIC, Granada, Spain
| | - Nerea M Molina
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Eduardo Andrés-León
- Bioinformatics Unit, Institute of Parasitology and Biomedicine "López-Neyra" (IPBLN), CSIC, Granada, Spain
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