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Ramboarina S, Crucitti T, Gill K, Bekker LG, Harding-Esch EM, van de Wijgert JHHM, Huynh BT, Fortas C, Harimanana A, Mayouya Gamana T, Randremanana RV, Mangahasimbola R, Dziva Chikwari C, Kranzer K, Mackworth-Young CRS, Bernays S, Thomas N, Anderson D, Tanko FR, Manhanzva M, Lurie M, Khumalo F, Sinanovic E, Honda A, Pidwell T, Francis SC, Masson L, Passmore JA. Novel point-of-care cytokine biomarker lateral flow test for the screening for sexually transmitted infections and bacterial vaginosis: study protocol of a multicentre multidisciplinary prospective observational clinical study to evaluate the performance and feasibility of the Genital InFlammation Test (GIFT). BMJ Open 2024; 14:e084918. [PMID: 38692732 PMCID: PMC11086546 DOI: 10.1136/bmjopen-2024-084918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION A prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1β has been developed as a point-of-care test-called the Genital InFlammation Test (GIFT)-for detecting genital inflammation associated with sexually transmitted infections (STIs) and/or bacterial vaginosis (BV) in women. In this paper, we describe the rationale and design for studies that will be conducted in South Africa, Zimbabwe and Madagascar to evaluate the performance of GIFT and how it could be integrated into routine care. METHODS AND ANALYSIS We will conduct a prospective, multidisciplinary, multicentre, cross-sectional and observational clinical study comprising two distinct components: a biomedical ('diagnostic study') and a qualitative, modelling and economic ('an integration into care study') part. The diagnostic study aims to evaluate GIFT's performance in identifying asymptomatic women with discharge-causing STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG)) and BV. Study participants will be recruited from women attending research sites and family planning services. Several vaginal swabs will be collected for the evaluation of cytokine concentrations (ELISA), STIs (nucleic acid amplification tests), BV (Nugent score) and vaginal microbiome characteristics (16S rRNA gene sequencing). The first collected vaginal swab will be used for the GIFT assay which will be performed in parallel by a healthcare worker in the clinic near the participant, and by a technician in the laboratory. The integration into care study aims to explore how GIFT could be integrated into routine care. Four activities will be conducted: user experiences and/or perceptions of the GIFT device involving qualitative focus group discussions and in-depth interviews with key stakeholders; discrete choice experiments; development of a decision tree classification algorithm; and economic evaluation of defined management algorithms. ETHICS AND DISSEMINATION Findings will be reported to participants, collaborators and local government for the three sites, presented at national and international conferences, and disseminated in peer-reviewed publications.The protocol and all study documents such as informed consent forms were reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC reference 366/2022), Medical Research Council of Zimbabwe (MRCZ/A/2966), Comité d'Ethique pour la Recherche Biomédicale de Madagascar (N° 143 MNSAP/SG/AMM/CERBM) and the London School of Hygiene and Tropical Medicine ethics committee (LSHTM reference 28046).Before the start, this study was submitted to the Clinicaltrials.gov public registry (NCT05723484). TRIAL REGISTRATION NUMBER NCT05723484.
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Affiliation(s)
| | | | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | | | | | | | - Bich-Tram Huynh
- Institut Pasteur, Université Paris Cité, France
- Université Paris-Saclay, Université Versailles Saint-Quentin, Inserm, France
| | - Camille Fortas
- Institut Pasteur, Université Paris Cité, France
- Université Paris-Saclay, Université Versailles Saint-Quentin, Inserm, France
| | | | | | | | | | - Chido Dziva Chikwari
- London School of Hygiene & Tropical Medicine, England
- Organization for Public Health Interventions and Development, Zimbabwe
- The Biomedical Research and Training Institute, Zimbabwe
| | - Katharina Kranzer
- London School of Hygiene & Tropical Medicine, England
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | | | - Sarah Bernays
- London School of Hygiene & Tropical Medicine, England
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Nicola Thomas
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - David Anderson
- Disease Elimination Program, Life Sciences Discipline,Burnet Institute, Melbourne, Australia
| | - Fatime Ramla Tanko
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Monalisa Manhanzva
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Micaela Lurie
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Fezile Khumalo
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Tanya Pidwell
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
| | | | - Lindi Masson
- Disease Elimination Program, Life Sciences Discipline,Burnet Institute, Melbourne, Australia
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Central Clinical School, Monash University, Victoria, Australia
- National Health Laboratory Service, Cape Town, South Africa
| | - Jo-Anne Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
- National Health Laboratory Service, Cape Town, South Africa
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Saadaoui M, Singh P, Ortashi O, Al Khodor S. Role of the vaginal microbiome in miscarriage: exploring the relationship. Front Cell Infect Microbiol 2023; 13:1232825. [PMID: 37780845 PMCID: PMC10533927 DOI: 10.3389/fcimb.2023.1232825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Miscarriage is a devastating pregnancy loss that affects many women worldwide. It is characterized as a spontaneous miscarriage that occurs before 20 weeks of gestation which affects more than 25% of pregnancies. While the causes of miscarriage are complex and multifactorial, recent research has suggested a potential role of the vaginal microbiota. The vaginal microbiome is a dynamic ecosystem of microbes that are essential for preserving vaginal health and avoiding infections. Vaginal dysbiosis has been accompanied with numerous adverse pregnancy complications, such as preterm birth. However, the effect of the vaginal microbiome in miscarriage is not fully understood. This review aims to investigate the link between vaginal microbiota and miscarriage. Also, we investigate the various mechanisms through which the vaginal microbiota may affect miscarriage. Additionally, we examine the implications of these research findings, specifically the possibility of vaginal microbiome screening and targeted interventions to prevent miscarriage.
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Affiliation(s)
| | - Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Osman Ortashi
- Women’s Services Department, Sidra Medicine, Doha, Qatar
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Lingasamy P, Modhukur V, Mändar R, Salumets A. Exploring Immunome and Microbiome Interplay in Reproductive Health: Current Knowledge, Challenges, and Novel Diagnostic Tools. Semin Reprod Med 2023; 41:172-189. [PMID: 38262441 PMCID: PMC10846929 DOI: 10.1055/s-0043-1778017] [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] [Indexed: 01/25/2024]
Abstract
The dynamic interplay between the immunome and microbiome in reproductive health is a complex and rapidly advancing research field, holding tremendously vast possibilities for the development of reproductive medicine. This immunome-microbiome relationship influences the innate and adaptive immune responses, thereby affecting the onset and progression of reproductive disorders. However, the mechanisms governing these interactions remain elusive and require innovative approaches to gather more understanding. This comprehensive review examines the current knowledge on reproductive microbiomes across various parts of female reproductive tract, with special consideration of bidirectional interactions between microbiomes and the immune system. Additionally, it explores innate and adaptive immunity, focusing on immunoglobulin (Ig) A and IgM antibodies, their regulation, self-antigen tolerance mechanisms, and their roles in immune homeostasis. This review also highlights ongoing technological innovations in microbiota research, emphasizing the need for standardized detection and analysis methods. For instance, we evaluate the clinical utility of innovative technologies such as Phage ImmunoPrecipitation Sequencing (PhIP-Seq) and Microbial Flow Cytometry coupled to Next-Generation Sequencing (mFLOW-Seq). Despite ongoing advancements, we emphasize the need for further exploration in this field, as a deeper understanding of immunome-microbiome interactions holds promise for innovative diagnostic and therapeutic strategies for reproductive health, like infertility treatment and management of pregnancy.
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Affiliation(s)
| | - Vijayachitra Modhukur
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Reet Mändar
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Santos FP, Carvalhos CA, Figueiredo-Dias M. New Insights into Photobiomodulation of the Vaginal Microbiome-A Critical Review. Int J Mol Sci 2023; 24:13507. [PMID: 37686314 PMCID: PMC10487748 DOI: 10.3390/ijms241713507] [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: 07/28/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
The development of new technologies such as sequencing has greatly enhanced our understanding of the human microbiome. The interactions between the human microbiome and the development of several diseases have been the subject of recent research. In-depth knowledge about the vaginal microbiome (VMB) has shown that dysbiosis is closely related to the development of gynecologic and obstetric disorders. To date, the progress in treating or modulating the VMB has lagged far behind research efforts. Photobiomodulation (PBM) uses low levels of light, usually red or near-infrared, to treat a diversity of conditions. Several studies have demonstrated that PBM can control the microbiome and improve the activity of the immune system. In recent years, increasing attention has been paid to the microbiome, mostly to the gut microbiome and its connections with many diseases, such as metabolic disorders, obesity, cardiovascular disorders, autoimmunity, and neurological disorders. The applicability of PBM therapeutics to treat gut dysbiosis has been studied, with promising results. The possible cellular and molecular effects of PBM on the vaginal microbiome constitute a theoretical and promising field that is starting to take its first steps. In this review, we will discuss the potential mechanisms and effects of photobiomodulation in the VMB.
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Affiliation(s)
- Fernanda P. Santos
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (C.A.C.); (M.F.-D.)
- Clinical and Academic Centre of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra Hospital and University Center, 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal
| | - Carlota A. Carvalhos
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (C.A.C.); (M.F.-D.)
- Clinical and Academic Centre of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra Hospital and University Center, 3004-561 Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (C.A.C.); (M.F.-D.)
- Clinical and Academic Centre of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra Hospital and University Center, 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3001-301 Coimbra, Portugal
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Miko E, Barakonyi A. The Role of Hydrogen-Peroxide (H 2O 2) Produced by Vaginal Microbiota in Female Reproductive Health. Antioxidants (Basel) 2023; 12:antiox12051055. [PMID: 37237921 DOI: 10.3390/antiox12051055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Female reproductive health is strongly associated with healthy vaginal microbiota, which is thought to be ensured by the dominance of certain Lactobacillus species. Lactobacilli control the vaginal microenvironment through several factors and mechanisms. One of them is their ability to produce hydrogen peroxide (H2O2). The role of Lactobacillus-derived H2O2 in the vaginal microbial community has been intensively investigated in several studies with many designs. However, results and data are controversial and challenging to interpret in vivo. Defining the underlying mechanisms responsible for a physiological vaginal ecosystem is crucial since it could directly affect probiotic treatment attempts. This review aims to summarize current knowledge on the topic, focusing on probiotic treatment possibilities.
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Affiliation(s)
- Eva Miko
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
- Janos Szentagothai Research Centre, 20 Ifjusag Street, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Aliz Barakonyi
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
- Janos Szentagothai Research Centre, 20 Ifjusag Street, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
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