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Dudick S, Goyal R, Hsu CD. Is there an association between vaginal microbiome community state types and diversity and preterm birth: A non-systematic literature review. Taiwan J Obstet Gynecol 2024; 63:610-613. [PMID: 39266138 DOI: 10.1016/j.tjog.2024.06.002] [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] [Accepted: 06/07/2024] [Indexed: 09/14/2024] Open
Abstract
Worldwide, preterm birth (PTB) is a significant cause of neonatal mortality and morbidity. Surprisingly, the rate of PTB in the United States is among the top 10 nations in the world, comparable to those of the Democratic Republic of the Congo, Bangladesh, India, and Nigeria. However, there is no predictive biomarker or understanding of the mechanisms of PTB. Recent evidence suggests that the vaginal microbiome can be clustered into Community State Types (CST) and is altered in various obstetrical syndromes. The review aimed to summarize multiple studies on the vaginal microbiome and PTB and identify a particular microbe or CST associated with PTB. We hypothesized that there exists a specific microorganism that, when dominant within the vaginal microbiome, is protective against PTB. We hypothesized that the absence of a particular microbe or CST is a risk factor for PTB. To answer this question, we reviewed the current literature aiming to identify such a microorganism or a group of microorganisms. Our results indicate that no particular microbe or CST can be implicated in PTB. However, the review suggests that an increase in alpha and beta diversity of the vaginal microbiome can be predictive and involved in the pathogenesis of PTB.
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Affiliation(s)
- Steven Dudick
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA.
| | - Ravi Goyal
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA
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2
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Garmendia JV, De Sanctis CV, Hajdúch M, De Sanctis JB. Microbiota and Recurrent Pregnancy Loss (RPL); More than a Simple Connection. Microorganisms 2024; 12:1641. [PMID: 39203483 PMCID: PMC11357228 DOI: 10.3390/microorganisms12081641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
Recurrent Pregnancy Loss (RPL) affects 1-2% of women, and its triggering factors are unclear. Several studies have shown that the vaginal, endometrial, and gut microbiota may play a role in RPL. A decrease in the quantity of Lactobacillus crispatus in local microbiota has been associated with an increase in local (vaginal and endometrial) inflammatory response and immune cell activation that leads to pregnancy loss. The inflammatory response may be triggered by gram-negative bacteria, lipopolysaccharides (LPS), viral infections, mycosis, or atypia (tumor growth). Bacterial structures and metabolites produced by microbiota could be involved in immune cell modulation and may be responsible for immune cell activation and molecular mimicry. Gut microbiota metabolic products may increase the amount of circulating pro-inflammatory lymphocytes, which, in turn, will migrate into vaginal or endometrial tissues. Local pro-inflammatory Th1 and Th17 subpopulations and a decrease in local Treg and tolerogenic NK cells are accountable for the increase in pregnancy loss. Local microbiota may modulate the local inflammatory response, increasing pregnancy success. Analyzing local and gut microbiota may be necessary to characterize some RPL patients. Although oral supplementation of probiotics has not been shown to modify vaginal or endometrial microbiota, the metabolites produced by it may benefit patients. Lactobacillus crispatus transplantation into the vagina may enhance the required immune tolerogenic response to achieve a normal pregnancy. The effect of hormone stimulation and progesterone to maintain early pregnancy on microbiota has not been adequately studied, and more research is needed in this area. Well-designed clinical trials are required to ascertain the benefit of microbiota modulation in RPL.
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Affiliation(s)
- Jenny Valentina Garmendia
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 1333/5, 779 00 Olomouc, Czech Republic; (J.V.G.); (M.H.)
| | - Claudia Valentina De Sanctis
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 1333/5, 779 00 Olomouc, Czech Republic; (J.V.G.); (M.H.)
| | - Marián Hajdúch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 1333/5, 779 00 Olomouc, Czech Republic; (J.V.G.); (M.H.)
- Czech Advanced Technology and Research Institute, Palacky University, 779 00 Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc (FNOL), Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Juan Bautista De Sanctis
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 1333/5, 779 00 Olomouc, Czech Republic; (J.V.G.); (M.H.)
- Czech Advanced Technology and Research Institute, Palacky University, 779 00 Olomouc, Czech Republic
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3
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Megli CJ, DePuyt AE, Goff JP, Munyoki SK, Hooven TA, Jašarević E. Diet influences community dynamics following vaginal group B streptococcus colonization. Microbiol Spectr 2024; 12:e0362323. [PMID: 38722155 PMCID: PMC11237455 DOI: 10.1128/spectrum.03623-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/22/2024] [Indexed: 06/06/2024] Open
Abstract
The vaginal microbiota plays a pivotal role in reproductive, sexual, and perinatal health and disease. Unlike the well-established connections between diet, metabolism, and the intestinal microbiota, parallel mechanisms influencing the vaginal microbiota and pathogen colonization remain overlooked. In this study, we combine a mouse model of Streptococcus agalactiae strain COH1 [group B Streptococcus (GBS)] vaginal colonization with a mouse model of pubertal-onset obesity to assess diet as a determinant of vaginal microbiota composition and its role in colonization resistance. We leveraged culture-dependent assessment of GBS clearance and culture-independent, sequencing-based reconstruction of the vaginal microbiota in relation to diet, obesity, glucose tolerance, and microbial dynamics across time scales. Our findings demonstrate that excessive body weight gain and glucose intolerance are not associated with vaginal GBS density or timing of clearance. Diets high in fat and low in soluble fiber are associated with vaginal GBS persistence, and changes in vaginal microbiota structure and composition due to diet contribute to GBS clearance patterns in nonpregnant mice. These findings underscore a critical need for studies on diet as a key determinant of vaginal microbiota composition and its relevance to reproductive and perinatal outcomes.IMPORTANCEThis work sheds light on diet as a key determinant influencing the composition of vaginal microbiota and its involvement in group B Streptococcus (GBS) colonization in a mouse model. This study shows that mice fed diets with different nutritional composition display differences in GBS density and timing of clearance in the female reproductive tract. These findings are particularly significant given clear links between GBS and adverse reproductive and neonatal outcomes, advancing our understanding by identifying critical connections between dietary components, factors originating from the intestinal tract, vaginal microbiota, and reproductive outcomes.
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Affiliation(s)
- Christina J. Megli
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Division of Maternal–Fetal Medicine, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
- Division of Reproductive Infectious Disease, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Allison E. DePuyt
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Julie P. Goff
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah K. Munyoki
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas A. Hooven
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Richard King Mellon Institute for Pediatric Research, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eldin Jašarević
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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4
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Schuster HJ, Bos AM, Himschoot L, van Eekelen R, Matamoros SP, de Boer MA, Oudijk MA, Ris-Stalpers C, Cools P, Savelkoul PH, Painter RC, van Houdt R. Vaginal microbiota and spontaneous preterm birth in pregnant women at high risk of recurrence. Heliyon 2024; 10:e30685. [PMID: 38803950 PMCID: PMC11128838 DOI: 10.1016/j.heliyon.2024.e30685] [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: 01/15/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
We describe vaginal microbiota, including Gardnerella species and sexually transmitted infections (STIs), during pregnancy and their associations with recurrent spontaneous preterm birth (sPTB). We performed a prospective cohort study in a tertiary referral centre in the Netherlands, among pregnant women with previous sPTB <34 weeks' gestation. Participants collected three vaginal swabs in the first and second trimester. Vaginal microbiota was profiled with 16S rDNA sequencing. Gardnerella species and STI's were tested with qPCR. Standard care was provided according to local protocol, including screening and treatment for bacterial vaginosis (BV), routine progesterone administration and screening for cervical length shortening. Of 154 participants, 26 (16.9 %) experienced recurrent sPTB <37 weeks' gestation. Microbiota composition was not associated with sPTB. During pregnancy, the share of Lactobacillus iners-dominated microbiota increased at the expense of diverse microbiota between the first and second trimester. This change coincided with treatment for BV, demonstrating a similar change in microbiota composition after treatment. In this cohort of high-risk women, we did not find an association between vaginal microbiota composition and recurrent sPTB. This should be interpreted with care, as these women were offered additional preventive therapies to reduce sPTB according to national guidelines including progesterone and BV treatment. The increase observed in L. iners dominated microbiota and the decrease in diverse microbiota mid-gestation was most likely mediated by BV treatment. Our findings suggest that in recurrent sPTB occurring despite several preventive therapies, the microbe-related etiologic contribution might be limited.
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Affiliation(s)
- Heleen J. Schuster
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Anouk M. Bos
- Amsterdam UMC Location University of Amsterdam, Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Lisa Himschoot
- Ghent University, Department of Diagnostic Sciences, Ghent, Belgium
| | - Rik van Eekelen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Sébastien P.F. Matamoros
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marjon A. de Boer
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Martijn A. Oudijk
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Carrie Ris-Stalpers
- Amsterdam UMC Location University of Amsterdam, Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Piet Cools
- Ghent University, Department of Diagnostic Sciences, Ghent, Belgium
| | - Paul H.M. Savelkoul
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Maastricht University Medical Center+, Medical Microbiology Infectious Diseases & Infection Prevention, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht, the Netherlands
| | - Rebecca C. Painter
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Robin van Houdt
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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5
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McKee K, Bassis CM, Golob J, Palazzolo B, Sen A, Comstock SS, Rosas-Salazar C, Stanford JB, O'Connor T, Gern JE, Paneth N, Dunlop AL. Host factors are associated with vaginal microbiome structure in pregnancy in the ECHO Cohort Consortium. Sci Rep 2024; 14:11798. [PMID: 38782975 PMCID: PMC11116393 DOI: 10.1038/s41598-024-62537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Using pooled vaginal microbiota data from pregnancy cohorts (N = 683 participants) in the Environmental influences on Child Health Outcomes (ECHO) Program, we analyzed 16S rRNA gene amplicon sequences to identify clinical and demographic host factors that associate with vaginal microbiota structure in pregnancy both within and across diverse cohorts. Using PERMANOVA models, we assessed factors associated with vaginal community structure in pregnancy, examined whether host factors were conserved across populations, and tested the independent and combined effects of host factors on vaginal community state types (CSTs) using multinomial logistic regression models. Demographic and social factors explained a larger amount of variation in the vaginal microbiome in pregnancy than clinical factors. After adjustment, lower education, rather than self-identified race, remained a robust predictor of L. iners dominant (CST III) and diverse (CST IV) (OR = 8.44, 95% CI = 4.06-17.6 and OR = 4.18, 95% CI = 1.88-9.26, respectively). In random forest models, we identified specific taxonomic features of host factors, particularly urogenital pathogens associated with pregnancy complications (Aerococcus christensenii and Gardnerella spp.) among other facultative anaerobes and key markers of community instability (L. iners). Sociodemographic factors were robustly associated with vaginal microbiota structure in pregnancy and should be considered as sources of variation in human microbiome studies.
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Grants
- U24OD023382 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- U2C OD023375 NIH HHS
- UH3 OD023271 NIH HHS
- UH3 OD023282 NIH HHS
- UH3OD023282 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023287 NIH HHS
- U24 OD023319 NIH HHS
- UH3 OD023305 NIH HHS
- K01 AI153558 NIAID NIH HHS
- UH3 OD023288 NIH HHS
- UH3OD023249 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- U24OD023319 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023349 NIH HHS
- UH3 OD023337 NIH HHS
- UH3 OD023328 NIH HHS
- U24 OD023382 NIH HHS
- UH3 OD023313 NIH HHS
- UH3 OD023289 NIH HHS
- UH3 OD023249 NIH HHS
- UH3 OD023389 NIH HHS
- UH3 OD023290 NIH HHS
- UH3OD023251 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023285 NIH HHS
- UH3 OD023275 NIH HHS
- UH3 OD023318 NIH HHS
- UH3 OD023248 NIH HHS
- U2COD023375 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023253 NIH HHS
- UH3 OD023272 NIH HHS
- UH3 OD023347 NIH HHS
- UH3OD023318 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023251 NIH HHS
- UH3 OD023279 NIH HHS
- UH3OD023285 Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health
- UH3 OD023244 NIH HHS
- UH3 OD023320 NIH HHS
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Affiliation(s)
- Kimberly McKee
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, USA.
| | - Christine M Bassis
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Golob
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Beatrice Palazzolo
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, USA
| | - Sarah S Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | | | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas O'Connor
- Departments of Neuroscience and Obstetrics & Gynecology, University of Rochester, Rochester, NY, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Nigel Paneth
- Departments of Epidemiology & Biostatistics and Pediatrics & Human Development, Michigan State University, East Lansing, MI, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
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6
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Wei X, Tsai MS, Liang L, Jiang L, Hung CJ, Jelliffe-Pawlowski L, Rand L, Snyder M, Jiang C. Vaginal microbiomes show ethnic evolutionary dynamics and positive selection of Lactobacillus adhesins driven by a long-term niche-specific process. Cell Rep 2024; 43:114078. [PMID: 38598334 DOI: 10.1016/j.celrep.2024.114078] [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: 09/15/2023] [Revised: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
The vaginal microbiome's composition varies among ethnicities. However, the evolutionary landscape of the vaginal microbiome in the multi-ethnic context remains understudied. We perform a systematic evolutionary analysis of 351 vaginal microbiome samples from 35 multi-ethnic pregnant women, in addition to two validation cohorts, totaling 462 samples from 90 women. Microbiome alpha diversity and community state dynamics show strong ethnic signatures. Lactobacillaceae have a higher ratio of non-synonymous to synonymous polymorphism and lower nucleotide diversity than non-Lactobacillaceae in all ethnicities, with a large repertoire of positively selected genes, including the mucin-binding and cell wall anchor genes. These evolutionary dynamics are driven by the long-term evolutionary process unique to the human vaginal niche. Finally, we propose an evolutionary model reflecting the environmental niches of microbes. Our study reveals the extensive ethnic signatures in vaginal microbial ecology and evolution, highlighting the importance of studying the host-microbiome ecosystem from an evolutionary perspective.
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Affiliation(s)
- Xin Wei
- MOE Key Laboratory of Biosystems Homeostasis & Protection, and Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang 310030, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Ming-Shian Tsai
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Liang Liang
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Liuyiqi Jiang
- MOE Key Laboratory of Biosystems Homeostasis & Protection, and Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang 310030, China
| | - Chia-Jui Hung
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Laura Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA.
| | - Michael Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Chao Jiang
- MOE Key Laboratory of Biosystems Homeostasis & Protection, and Zhejiang Provincial Key Laboratory of Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang 310030, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
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7
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Pedro NA, Mira NP. A molecular view on the interference established between vaginal Lactobacilli and pathogenic Candida species: Challenges and opportunities for the development of new therapies. Microbiol Res 2024; 281:127628. [PMID: 38246122 DOI: 10.1016/j.micres.2024.127628] [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: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Vaginal infectious diseases caused by viruses and bacteria have been linked to the occurrence of dysbiosis, that is, a reduction in the abundance of the normally dominating vaginal Lactobacillus species. Mucosal infections in the vagina and/or vulva caused by Candida species, usually known as vulvovaginal candidiasis (or VVC), are among the leading causes of diseases in the vaginal tract. The existence of a clear link between the occurrence of dysbiosis and the development of VVC is still unclear, although multiple observations point in that direction. Based on the idea that vaginal health is linked to a microbiota dominated by lactobacilli, several probiotics have been used in management of VVC, either alone or in combination with antifungals, having obtained different degrees of success. In most cases, the undertaken trials resorted to lactobacilli species other than those indigenous to the vaginal tract, although in vitro these vaginal species were shown to reduce growth, viability and virulence of Candida. In this paper we overview the role of lactobacilli and Candida in the vaginal micro- and myco-biomes, while discussing the results obtained in what concerns the establishment of interference mechanisms in vivo and the environmental factors that could determine that. We also overview the molecular mechanisms by which lactobacilli species have been shown to inhibit pathophysiology of Candida, including the description of the genes and pathways determining their ability to thrive in the presence of each other. In a time where concerns are increasing with the emergence of antifungal resistance and the slow pace of discovery of new antifungals, a thorough understanding of the molecular mechanisms underneath the anti-Candida effect prompted by vaginal lactobacilli is of utmost importance to assure a knowledge-based design of what can be a new generation of pharmaceuticals, eventually focusing therapeutic targets other than the usual ones.
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Affiliation(s)
- Nuno A Pedro
- iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico - Department of Bioengineering, Universidade de Lisboa, 1049-001 Lisboa, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Nuno P Mira
- iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico - Department of Bioengineering, Universidade de Lisboa, 1049-001 Lisboa, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal.
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8
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Joseph A, Anton L, Guan Y, Ferguson B, Mirro I, Meng N, France M, Ravel J, Elovitz MA. Extracellular vesicles from vaginal Gardnerella vaginalis and Mobiluncus mulieris contain distinct proteomic cargo and induce inflammatory pathways. NPJ Biofilms Microbiomes 2024; 10:28. [PMID: 38514622 PMCID: PMC10957959 DOI: 10.1038/s41522-024-00502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Colonization of the vaginal space with bacteria such as Gardnerella vaginalis and Mobiluncus mulieris is associated with increased risk for STIs, bacterial vaginosis, and preterm birth, while Lactobacillus crispatus is associated with optimal reproductive health. Although host-microbe interactions are hypothesized to contribute to reproductive health and disease, the bacterial mediators that are critical to this response remain unclear. Bacterial extracellular vesicles (bEVs) are proposed to participate in host-microbe communication by providing protection of bacterial cargo, delivery to intracellular targets, and ultimately induction of immune responses from the host. We evaluated the proteome of bEVs produced in vitro from G. vaginalis, M. mulieris, and L. crispatus, identifying specific proteins of immunologic interest. We found that bEVs from each bacterial species internalize within cervical and vaginal epithelial cells, and that epithelial and immune cells express a multi-cytokine response when exposed to bEVs from G. vaginalis and M. mulieris but not L. crispatus. Further, we demonstrate that the inflammatory response induced by G. vaginalis and M. mulieris bEVs is TLR2-specific. Our results provide evidence that vaginal bacteria communicate with host cells through secreted bEVs, revealing a mechanism by which bacteria lead to adverse reproductive outcomes associated with inflammation. Elucidating host-microbe interactions in the cervicovaginal space will provide further insight into the mechanisms contributing to microbiome-mediated adverse outcomes and may reveal new therapeutic targets.
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Affiliation(s)
- Andrea Joseph
- Women's Biomedical Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA.
| | - Lauren Anton
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yuxia Guan
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Briana Ferguson
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Isabella Mirro
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nova Meng
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael France
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michal A Elovitz
- Women's Biomedical Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
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9
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Li KT, Li F, Jaspan H, Nyemba D, Myer L, Aldrovandi G, Joseph-Davey D. Changes in the Vaginal Microbiome During Pregnancy and the Postpartum Period in South African Women: a Longitudinal Study. Reprod Sci 2024; 31:275-287. [PMID: 37721699 PMCID: PMC10784382 DOI: 10.1007/s43032-023-01351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
Pregnant women in sub-Saharan Africa have high rates of maternal morbidity. There is interest in the impact of the vaginal microbiome on maternal health, including HIV and sexually transmitted infection (STI) acquisition. We characterized the vaginal microbiota of South African women ≥ 18 years with and without HIV in a longitudinal cohort over two visits during pregnancy and one visit postpartum. At each visit, we obtained HIV testing and self-collected vaginal swabs for point-of-care testing for STIs and microbiota sequencing. We categorized microbial communities and evaluated changes over pregnancy and associations with HIV status and STI diagnosis. Across 242 women (mean age 29, 44% living with HIV, 33% diagnosed with STIs), we identified four main community state types (CSTs): two lactobacillus-dominant CSTs (dominated by Lactobacillus crispatus and Lactobacillus iners respectively) and two diverse, non-lactobacillus-dominant CSTs (one dominated by Gardnerella vaginalis and one by diverse facultative anaerobes). From the first antenatal visit to the third trimester (24-36 weeks gestation), 60% of women in the Gardnerella-dominant CST shifted to lactobacillus-dominant CSTs. From the third trimester to postpartum (mean 17 days post-delivery), 80% of women in lactobacillus-dominant CSTs shifted to non-lactobacillus-dominant CSTs with a large proportion in the facultative anaerobe-dominant CST. Microbial composition differed by STI diagnosis (PERMANOVA R2 = 0.002, p = 0.004), and women diagnosed with an STI were more likely to be categorized as L. iners-dominant or Gardnerella-dominant CSTs. Overall, we found a shift toward lactobacillus dominance during pregnancy and the emergence of a distinct, highly diverse anaerobe-dominant microbiota profile in the postpartum period.
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Affiliation(s)
- Katherine T Li
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Fan Li
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Heather Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Departments of Pediatrics and Global Health, University of Washington, Seattle, WA, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dorothy Nyemba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Grace Aldrovandi
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Dvora Joseph-Davey
- Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
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10
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Hadley M, Oppong AY, Coleman J, Powell AM. Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome. Obstet Gynecol 2023; 142:911-919. [PMID: 37678901 PMCID: PMC10510805 DOI: 10.1097/aog.0000000000005345] [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: 02/01/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
Microbiome science offers a glimpse into personalized medicine by characterizing health and disease states according to an individual's microbial signatures. Without a critical examination of the use of race as a variable, microbiome studies may be susceptible to the same pitfalls as other areas of science grounded in racist biology. We will examine the use of race as a biological variable in pregnancy-related microbiome research. Emerging data from studies that investigate the intestinal microbiome in pregnancy suggest strong influence of a poor diet on adverse pregnancy outcomes. Differences in the vaginal microbiome implicated in adverse pregnancy outcomes are frequently attributed to race. We review evidence that links systemic racism to pregnancy health outcome differences with a focus on the vaginal and intestinal microbiomes as well as diet. We also review how structural racism ultimately contributes to inequitable access to healthy food and higher risk environmental exposures among pregnant people of lower socioeconomic status and exacerbates common pregnancy comorbidities.
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Affiliation(s)
- Megan Hadley
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and the University of Chicago School of Medicine, Chicago, Illinois
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11
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Oyebode IH, Just AC, Ravel J, Elovitz MA, Burris HH. Impact of exposure to air pollution on cervicovaginal microbial communities. ENVIRONMENTAL RESEARCH 2023; 233:116492. [PMID: 37354930 PMCID: PMC10527781 DOI: 10.1016/j.envres.2023.116492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Vaginal microbial communities can be dominated by anaerobic (community state type IV, CST IV) or Lactobacillus (other CSTs) species. CST IV is a risk factor for spontaneous preterm birth (sPTB) and is more common among Black than White populations. In the US, average air pollution exposures are higher among Black compared to White people and exert systemic health effects. We sought to (1) quantify associations of air pollution, specifically particulate matter <2.5 μm in diameter (PM2.5), with CST IV and (2) explore the extent to which racial disparities in PM2.5 exposure might explain racial differences in the prevalence of CST IV. DESIGN Methods: We performed a secondary analysis of 566 participants of the Motherhood & Microbiome study. PM2.5 exposures were derived from a machine learning model integrating NASA satellite and EPA ground monitor data. Previously, cervicovaginal swabs from 15 to 20 weeks' gestation were analyzed using 16 S rRNA sequencing and hierarchical clustering assigned CSTs. Multivariable logistic regression models calculated adjusted odds ratios of CST IV (vs. other CSTs) per interquartile range (IQR) increment of PM2.5. Race-stratified and mediation analyses were performed. RESULTS Higher PM2.5 exposure was associated with CST IV (aOR 1.39, 95% CI 1.02-1.91). Further adjustment for race/ethnicity attenuated the association (aOR 1.34, 95% CI: 0.97-1.83). Black participants (vs. White) had higher median PM2.5 exposure (10.6 vs. 9.6 μg/m3, P < 0.001) and higher prevalence of CST IV (47% vs. 11%, P < 0.001). Mediation analysis revealed that higher PM2.5 exposure may explain 3.9% (P = 0.038) and 3.3% (P = 0.15) of the Black-White disparity in CST IV in unadjusted and adjusted models, respectively. CONCLUSION PM2.5 was associated with CST IV, a risk factor for sPTB. Additionally, PM2.5 exposure may partially explain racial differences in the prevalence of CST IV. Further research is warranted to discover how environmental exposures affect microbial composition and perpetuate racial health disparities.
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Affiliation(s)
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacques Ravel
- Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michal A Elovitz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather H Burris
- Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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12
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Holliday M, Uddipto K, Castillo G, Vera LE, Quinlivan JA, Mendz GL. Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero. Microorganisms 2023; 11:1877. [PMID: 37630436 PMCID: PMC10456767 DOI: 10.3390/microorganisms11081877] [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: 06/25/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this work was to achieve a better understanding of the bacterial pathogens associated with stillbirths that would serve to inform clinical interventions directed at reducing this adverse pregnancy outcome. A prospective observational study was conducted with the participation of 22 women from northern Peru, of whom 11 experienced fetal death in utero and 11 delivered preterm births. Swabs were taken from the vagina, placenta, amniotic fluid and axilla of the infant at birth by Caesarean section. The bacterial populations in the vagina and the amniotic space of each participant were determined by employing the amplicon sequencing of the V4 region of the 16S rRNA genes. The sequence data were analysed using bioinformatics tools. The work showed differences in the composition of the genital microbiomes of women who experienced preterm birth or fetal death in utero. There were no differences in the alpha diversity between the genital microbiotas of both groups of women, but there were more different taxa in the vagina and amniotic space of the preterm participants. Lactobacillus spp. was less abundant in the stillbirth cases. E. coli/Shigella, Staphylococcus, Gardnerella, Listeria and Bacteroides taxa were associated with the stillbirths. In each woman, there was a minimal concordance between the bacterial populations in the vagina and amniotic space.
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Affiliation(s)
- Mira Holliday
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia; (M.H.); (J.A.Q.)
| | - Kumar Uddipto
- School of Medicine, Sydney, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
| | - Gerardo Castillo
- Área de Ciencias Biomédicas y Policlínico, University of Piura, San Eduardo, Piura 20009, Peru; (G.C.); (L.E.V.)
| | - Luz Estela Vera
- Área de Ciencias Biomédicas y Policlínico, University of Piura, San Eduardo, Piura 20009, Peru; (G.C.); (L.E.V.)
| | - Julie A. Quinlivan
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia; (M.H.); (J.A.Q.)
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - George L. Mendz
- School of Medicine, Sydney, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
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Carter KA, Fodor AA, Balkus JE, Zhang A, Serrano MG, Buck GA, Engel SM, Wu MC, Sun S. Vaginal Microbiome Metagenome Inference Accuracy: Differential Measurement Error according to Community Composition. mSystems 2023; 8:e0100322. [PMID: 36975801 PMCID: PMC10134888 DOI: 10.1128/msystems.01003-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Several studies have compared metagenome inference performance in different human body sites; however, none specifically reported on the vaginal microbiome. Findings from other body sites cannot easily be generalized to the vaginal microbiome due to unique features of vaginal microbial ecology, and investigators seeking to use metagenome inference in vaginal microbiome research are "flying blind" with respect to potential bias these methods may introduce into analyses. We compared the performance of PICRUSt2 and Tax4Fun2 using paired 16S rRNA gene amplicon sequencing and whole-metagenome sequencing data from vaginal samples from 72 pregnant individuals enrolled in the Pregnancy, Infection, and Nutrition (PIN) cohort. Participants were selected from those with known birth outcomes and adequate 16S rRNA gene amplicon sequencing data in a case-control design. Cases experienced early preterm birth (<32 weeks of gestation), and controls experienced term birth (37 to 41 weeks of gestation). PICRUSt2 and Tax4Fun2 performed modestly overall (median Spearman correlation coefficients between observed and predicted KEGG ortholog [KO] relative abundances of 0.20 and 0.22, respectively). Both methods performed best among Lactobacillus crispatus-dominated vaginal microbiotas (median Spearman correlation coefficients of 0.24 and 0.25, respectively) and worst among Lactobacillus iners-dominated microbiotas (median Spearman correlation coefficients of 0.06 and 0.11, respectively). The same pattern was observed when evaluating correlations between univariable hypothesis test P values generated with observed and predicted metagenome data. Differential metagenome inference performance across vaginal microbiota community types can be considered differential measurement error, which often causes differential misclassification. As such, metagenome inference will introduce hard-to-predict bias (toward or away from the null) in vaginal microbiome research. IMPORTANCE Compared to taxonomic composition, the functional potential within a bacterial community is more relevant to establishing mechanistic understandings and causal relationships between the microbiome and health outcomes. Metagenome inference attempts to bridge the gap between 16S rRNA gene amplicon sequencing and whole-metagenome sequencing by predicting a microbiome's gene content based on its taxonomic composition and annotated genome sequences of its members. Metagenome inference methods have been evaluated primarily among gut samples, where they appear to perform fairly well. Here, we show that metagenome inference performance is markedly worse for the vaginal microbiome and that performance varies across common vaginal microbiome community types. Because these community types are associated with sexual and reproductive outcomes, differential metagenome inference performance will bias vaginal microbiome studies, obscuring relationships of interest. Results from such studies should be interpreted with substantial caution and the understanding that they may over- or underestimate associations with metagenome content.
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Affiliation(s)
- Kayla A. Carter
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Anthony A. Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jennifer E. Balkus
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Angela Zhang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Myrna G. Serrano
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gregory A. Buck
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Computer Science, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Stephanie M. Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael C. Wu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Shan Sun
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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14
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Zhao F, Hu X, Ying C. Advances in Research on the Relationship between Vaginal Microbiota and Adverse Pregnancy Outcomes and Gynecological Diseases. Microorganisms 2023; 11:microorganisms11040991. [PMID: 37110417 PMCID: PMC10146011 DOI: 10.3390/microorganisms11040991] [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: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The human microbiota inhabiting different parts of the body has been shown to have a significant impact on human health, with the gut microbiota being the most extensively studied in relation to disease. However, the vaginal microbiota is also an essential commensal microbiota in the female body that plays a crucial role in female health. Despite receiving less attention than gut microbiota, its importance in regulating reproductive immunity and its complex dynamic properties have been increasingly recognized in recent years. Advances in research on the relationship between vaginal microbiota and pregnancy outcomes & gynecological diseases in women have shed light on the importance of maintaining a healthy vaginal microbiota. In this review, we aim to compile recent developments in the study of the vaginal microbial ecosystem and its role in female health and reproductive outcomes. We provide a comprehensive account of the normal vaginal microbiota, the association between the vaginal microbiota and pregnancy outcomes, and the impact of the vaginal microbiota on gynecological diseases in women. By reviewing recent research, we hope to contribute to the advancement of academic medicine's understanding of the vaginal microbiota's importance in female health. We also aim to raise awareness among healthcare professionals and the general public of the significance of maintaining a healthy vaginal microbiota for better reproductive health and the prevention of gynecological diseases.
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Affiliation(s)
- Fuju Zhao
- Clinical Laboratory, Huadong Hospital, Fudan University, Shanghai 200031, China
- Clinical Laboratory, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Xianyang Hu
- Huadong Hospital, Fudan University, Shanghai 200031, China
| | - Chunmei Ying
- Clinical Laboratory, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
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15
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The Vaginal Microbiome in Health and Disease-What Role Do Common Intimate Hygiene Practices Play? Microorganisms 2023; 11:microorganisms11020298. [PMID: 36838262 PMCID: PMC9959050 DOI: 10.3390/microorganisms11020298] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
The vaginal microbiome is a dynamic, sensitive microenvironment. The hallmark of a 'healthy' vaginal microbiome is currently believed to be one dominated by Lactobacillus spp., which acidifies the vaginal environment and help to protect against invading pathogens. However, a 'normal' microbiome is often difficult, if not impossible, to characterise given that it varies in response to numerous variables, including pregnancy, the menstrual cycle, contraceptive use, diet, ethnicity, and stress. A Lactobacillus-depleted microbiome has been linked to a variety of adverse vaginal health outcomes, including preterm birth (PTB), bacterial vaginosis (BV), and increased risk of sexually transmitted infections. The latter two of these have also been associated with feminine intimate hygiene practices, many of which are practised without any evidence of health benefits. The most extensively studied practice is vaginal douching, which is known to cause vaginal dysbiosis, predisposing women to BV, pelvic inflammatory disease, and PTB. However, little is known of the impact that intimate hygiene practices and associated products have on the vaginal microbiome. This review aims to outline the major factors influencing the vaginal microbiome and common vaginal infections, as well as to summarise current research surrounding the impact of hygiene products and practices on the vaginal microbiome.
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16
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Thomas-White K, Navarro P, Wever F, King L, Dillard LR, Krapf J. Psychosocial impact of recurrent urogenital infections: a review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231216537. [PMID: 38099456 PMCID: PMC10725120 DOI: 10.1177/17455057231216537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/12/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections.
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Affiliation(s)
| | | | | | | | - Lillian R Dillard
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Jill Krapf
- The Centers for Vulvovaginal Disorders, Washington, DC, USA
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17
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You YA, Park S, Kim K, Kwon EJ, Hur YM, Kim SM, Lee G, Ansari A, Park J, Kim YJ. Transition in vaginal Lactobacillus species during pregnancy and prediction of preterm birth in Korean women. Sci Rep 2022; 12:22303. [PMID: 36566290 PMCID: PMC9789976 DOI: 10.1038/s41598-022-26058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
The predominance of vaginal Lactobacillus species, specifically L. crispatus, is important for pregnancy maintenance, but varies by race. The composition of the vaginal microbiome can affect susceptibility to adverse pregnancy outcomes. We performed 16S rRNA gene amplicon sequencing on vaginal swabs taken from Korean pregnant women. Here, we report the transition of Lactobacillus spp. in samples of full-term birth (FTB) collected longitudinally in the second and third trimesters of pregnancy in a cohort study (n = 23) and their association with Lactobacillus abundance and preterm birth (PTB) in a case-control study (n = 200). Lactobacillus species, which was dominant in FTB samples including those that received interventions in the second trimester, did not change until 37 weeks of gestation. However, L. crispatus was replaced by other Lactobacillus species after 37 weeks. The PTB risk showed a closer association with the Lactobacillus abundance than with community state type determined by Lactobacillus species. PTB was associated with less than 90% of Lactobacillus abundance and an increase in Ureplasma parvum in the second trimester. Thus, the vaginal microbiome may change in preparation for childbirth in response to multiple intrinsic factors after 37 weeks of gestation. Monitoring the Lactobacillus abundance may help improve the reliability of microbial PTB biomarkers.
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Affiliation(s)
- Young-Ah You
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea
| | - Sunwha Park
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Womans University Mok Dong Hospital, Seoul, 158-051 South Korea
| | | | - Eun Jin Kwon
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea
| | - Young Min Hur
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Womans University Mok Dong Hospital, Seoul, 158-051 South Korea
| | - Soo Min Kim
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Gain Lee
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - AbuZar Ansari
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | | | - Young Ju Kim
- grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Medical Research Institute, Ewha Womans University Medical School, Seoul, 07985 Republic of Korea ,grid.255649.90000 0001 2171 7754Department of Obstetrics and Gynecology, Ewha Womans University Mok Dong Hospital, Seoul, 158-051 South Korea ,grid.255649.90000 0001 2171 7754Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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18
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Chopra C, Bhushan I, Mehta M, Koushal T, Gupta A, Sharma S, Kumar M, Khodor SA, Sharma S. Vaginal microbiome: considerations for reproductive health. Future Microbiol 2022; 17:1501-1513. [DOI: 10.2217/fmb-2022-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The microbial communities are an indispensable part of the human defense system and coexist with humans as symbionts, contributing to the metabolic functions and immune defense against pathogens. An ecologically stable vaginal microbiota is dominated by Lactobacillus species, which plays an important role in the prevention of genital infections by controlling the vaginal pH, reducing glycogen to lactic acid, and stimulating bacteriocins and hydrogen peroxide. In contrast, an abnormal vaginal microbial composition is associated with an increased risk of bacterial vaginosis, trichomoniasis, sexually transmitted diseases, preterm labor and other birth defects. This microbial diversity is affected by race, ethnicity, pregnancy, hormonal changes, sexual activities, hygiene practices and other conditions. In the present review, we discuss the changes in the microbial community of the vaginal region at different stages of a female's life cycle and its influence on her reproductive health and pathological conditions.
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Affiliation(s)
- Chitrakshi Chopra
- School of Biotechnology, Shri Mata Vaishno Devi University, Katra, Jammu & Kashmir, 182320, India
| | - Indu Bhushan
- School of Biotechnology, Shri Mata Vaishno Devi University, Katra, Jammu & Kashmir, 182320, India
| | - Malvika Mehta
- School of Biotechnology, Shri Mata Vaishno Devi University, Katra, Jammu & Kashmir, 182320, India
| | - Tanvi Koushal
- School of Biotechnology, Shri Mata Vaishno Devi University, Katra, Jammu & Kashmir, 182320, India
| | - Amita Gupta
- Department of Gynecology, Government Medical College, Jammu, (J&K), 180001, India
| | - Sarika Sharma
- Department of Sponsored Research, Division of Research & Development, Lovely Professional University, Phagwara, 144411, India
| | - Manoj Kumar
- Research Department, Sidra Medicine, Doha, 26999, Qatar
| | | | - Sandeep Sharma
- Department of Medical Laboratory Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
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