Renaissance of the vaginal microbiota: reframing clinical paradigms
DOI: 10.32364/2618-8430-2022-5-4-303-308
G.N. Minkina1, K.R. Bondarenko2, M.S. Selikhova3, P.A. Soltys3
1A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
2Pirogov Russian National Research Medical University, Moscow, Russian Federation
3Volgograd State Medical University, Volgograd, Russian Federation
One of the promising options for reducing the prevalence of inflammatory diseases of the genital organs and preventing their recurrence is to achieve and maintain a normal vaginal microbiome as the first line of natural protection against infections. Medications comprising antibacterial and/or antifungal agents which are widely used in the treatment of abnormal vaginal discharges may cause a substantial decrease in woman’s own lactobacilli. Over the last decade, researchers have focused on probiotics which increase the efficacy of treatment and reduce the rate of disease recurrences. As known, the human gut microbiota plays a central role in the development of healthy microbiome of its host and biotopes of various locations. Thus, the currently preferred oral probiotics include combination products for oral intake which contain multiple symbiont bacterial strains and prebiotic components. An oral probiotic comprising a combination of two lactic acid bacteria wi th synergistic effect, Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14 that remain viable after passing through the gastrointestinal tract and maintain ability to colonize the vagina as well as other organs and are characterized by a high level of adhesion to vaginal epithelial cells, helps to increase the lactobacilli count, normalizing microbiome in the woman’s vagina. The recent clinical trials have demonstrated the efficacy of oral administration of the combination of two strains of lactic acid bacteria, L. rhamnosus HN001 and L. acidophilus La-14, in the prevention of recurrences of bacterial vaginosis and vulvovaginal candidiasis with the aim of maintaining and normalizing vaginal microbiome; this combination is approved for taking during pregnancy and breastfeeding.
Keywords: vaginal infections, microbiome, probiotics, oral intake, symbiont bacterial strains, normal vaginal biocenosis.
For citation: Minkina G.N., Bondarenko K.R., Selikhova M.S., Soltys P.A. Renaissance of the vaginal microbiota: reframing clinical paradigms. Russian Journal of Woman and Child Health. 2022;5(4):303–308 (in Russ.). DOI: 10.32364/2618-8430-2022-5-4-303-308.
About the authors:
Galina N. Minkina — Dr. Sc. (Med.), Professor of the Department of Obstetrics and Gynecology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry; 20/1, Delegatskaya str., Moscow, 127473, Russian Federation; ORCID iD 0000-0002-7594-6277.
Karina R. Bondarenko — Dr. Sc. (Med.), associate professor of the Department of Obstetrics and Gynecology of the Faculty of Medicine, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0003-4147-1151.
Marina S. Selikhova — Dr. Sc. (Med.), Professor of the Department of Obstetrics and Gynecology, Volgograd State Medical University; 1, Pavshikh Bortsov sq., Volgograd, 400131, Russian Federation; ORCID iD 0000-0002-4393-6111.
Polina A. Soltys — C. Sc. (Med.), assistant of the Department of Obstetrics and Gynecology, Volgograd State Medical University; 1, Pavshikh Bortsov sq., Volgograd, 400131, Russian Federation; ORCID iD 0000-0002-1911-5372.
Contact information: Marina S. Selikhova, e-mail: selichovamarina@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 26.09.2022.
Revised 19.10.2022.
Accepted 14.11.2022.
2. Tapilskaya N.I., Karpeev S.A., Kuznetsova I.V. Chronic endometritis is a subclinical inflammatory disease of the pelvic organs. Gynecology. 2014;1:104–109 (in Russ.).
3. Abdelmaksoud A.A., Koparde V.N., Sheth N.U. Comparison of Lactobacillus crispatus isolates from Lactobacillus-dominated vaginal microbiomes with isolates from microbiomes containing bacterial vaginosis-associated bacteria. Microbiology. 2016;162(3):466–475. DOI: 10.1099/mic.0.000238.
4. Blaser M.J. The microbiome revolution. J Clin Invest. 2014;124(10):4162–4165. DOI: 10.1172/JCI78366.
5. Tojo R., Suárez A., Clemente M.G. et al. Intestinal microbiota in health and disease: role of bifidobacteria in gut homeostasis. World J Gastroenterol. 2014;20(41):15163–15176. DOI: 10.3748/wjg.v20.i41.15163.
6. Ogunrinola G.A., Oyewale J.O., Oshamika O.O., Olasehinde G.I. The Human Microbiome and Its Impacts on Health. Int J Microbiol. 2020;2020:8045646. DOI: 10.1155/2020/8045646.
7. Perez-Muñoz M.E., Arrieta M.C., Ramer-Tait A.E., Walter J. A critical assessment of the "sterile womb" and "in utero colonization" hypotheses: implications for research on the pioneer infant microbiome. Microbiome. 2017;5(1):48. DOI: 10.1186/s40168-017-0268-4.
8. European Guideline for the Management of Pelvic Inflammatory Disease. (Electronic resource.) URL: http://www.iusti.org/regions/Europe/pdf/2015/PID_Treatment_Guidelines-Europe2015v5.pdf (access date: 09.11.2022).
9. Dukhin A.O., Luybeshkina V.A., Taraskina E.V. Chronic pelvic inflammatory disease: controversial issues. RUDN Journal of medicine. 2013;5:201–209 (in Russ.).
10. Chertovskih M.N., Kulinich S.I. Optimization of the pregravidal examination of patients with unsuccessful programs of assisted reproductive technology (patients with infertility). Acta Biomedica Scientifica. 2013;(2(2)):83–86 (in Russ.).
11. Manukhin I.B., Firichenko S.V., Smirnova S.O., Vuchenovich Yu.D. Vaginal microbiota. Diagnosis, impact on women’s health and correction of disorders: Textbook. M.: Glavprint; 2015:61–62 (in Russ.).
12. Sharma H., Tal R., Clark N.A. et al. Microbiota and pelvic inflammatory disease. Reprod Med. 2014;32(1):43–49. DOI: 10.1055/s-0033-1361822.
13. Walther-António M.R., Chen J., Multinu F. et al. Potential contribution of the uterine microbiome in the development of endometrial cancer. Genome Med. 2016;8(1):122. DOI: 10.1186/s13073-016-0368-y.
14. Moreno I., Codoñer F.M., Vilella F. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016;215(6):684–703. DOI: 10.1016/j.ajog.2016.09.
15. Kira E.F. Bacterial vaginosis. M.: MIA; 2012 (in Russ.).
16. Bondarenko K.R., Ozolinya L.A., Bondarenko V.M., Shpirko V.O. Features of Vaginal Microecosystem in Gestational Period: a Literature Review. Bulletin of RSMU. 2014;(4):6–11 (in Russ.).
17. Ardatskaya M.D. Probiotics, prebiotics and metabiotics in the management of microecological bowel disorders. Medical Council. 2015;(13):94–99 (in Russ.). DOI: 10.21518/2079-701X-2015-13-94-99.
18. Harper A., Vijayakumar V., Ouwehand A.C. et al. Viral Infections, the Microbiome, and Probiotics. Front Cell Infect Microbiol. 2021;10:596166. DOI: 10.3389/fcimb.2020.596166.
19. Bondarenko V.M., Bondarenko K.R., Rybalchenko O.V., Ozolinya L.A. Features of the microsystem in bacterial vaginosis and the possibility of its regulation with the help of probiotics. Treatment and Prevention. 2014;2:17–27 (in Russ.).
20. Tikhomirov A.L., Oleinik Ch.G. Probiotics in the complex treatment of vulvovaginal candidiasis. Effective Pharmacotherapy. 2007;4:14–20 (in Russ.).
21. Bertuccini L., Russo R., Losi F., Superti F. Effects of Lactobacillus rhamnosus and Lactobacillus acidophilus on bacterial vaginal pathogens. Int J Immunopathol Pharmacol. 2017;30(2):163–167. DOI: 10.1177/0394632017697987.
22. Novikova S.V., Logutova L.S., Ignatyeva M.A. Clinical evaluation of the efficacy and safety of the use of vagilac to treat bacterial vaginosis in pregnancy. Medical Council. 2018;(13):90–94 (in Russ.). DOI: 10.21518/2079-701X-2018-13-90-94.
23. Sinyakova A.A., Shipitsyna E.V., Budilovskaya O.V. et al. Anamnestic and microbiological predictors of miscarriage. Journal of Obstetrics and Women’s Diseases. 2019;68(2):59–70 (in Russ.). DOI: 10.17816/JOWD68259-70.
24. Dobrokhotova Yu.E., Bondarenko K.R., Shadrova P.A. Current view on infectious factor of early reproductive losses and possible pathogenetic mechanisms. Russian Journal of Human Reproduction. 2020;26(3):23–30 (in Russ.). DOI: 10.17116/repro20202603123.
25. Radzinskiy V.E., Manukhin I.B., Ordiyants I.M. et al. Efficacy of normalization of vaginal microbiota after antimicrobial treatment for bacterial vaginosis and bacterial vaginosis in pregnant women (results of the multicenter prospective non-interventional comparative study). Russian Journal of Woman and Child Health. 2021;4(3):192–200 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-192-200.
26. Wickens K.L., Barthow C.A., Murphy R. et al. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial. Br J Nutr. 2017;117(6):804–813. DOI: 10.1017/S0007114517000289.
27. Barthow C., Wickens K., Stanley T. et al. The probiotics in pregnancy study (PIP Study) rationale and design of a double-blind randomized controlled trial to improve maternal health during pregnancy and prevent infant eczame and allergy. BMC Pregnancy childbirth. 2016;16(1):133. DOI: 10.1186/s12884-016-0923-y.
28. Slykerman R.F., Hood F., Wickens K. et al. Probiotic in Pregnancy Study Group. Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine. 2017;24:159–165. DOI: 10.1016/j.ebiom.2017.09.013.
29. Amabebe E., Anumba D.O.C. Female Gut and Genital Tract Microbiota-Induced Crosstalk and Differential Effects of Short-Chain Fatty Acids on Immune Sequelae. Front Immunol. 2020;11:2184. DOI: 10.3389/fimmu.2020.02184.
30. Korshunov V.M., Volodin N.N., Efimov B.A. et al. Microecology of the vagina. Correction of microflora in vaginal dysbacteriosis. M: VUNMTs of the Ministry of Health of the Russian Federation; 1999 (in Russ.).
31. De Alberti D., Russo R., Terruzzi F. et al. Lactobacilli vaginal colonisation after oral consumption of Respecta(®) complex: a randomised controlled pilot study. Arch Gynecol Obstet. 2015;292(4):861–867. DOI: 10.1007/s00404-015-3711-4.
32. Xie H.Y., Feng D., Wei D.M. et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev. 2017;11(11):CD010496. DOI: 10.1002/14651858.CD010496.pub2.
33. Munoz-Barreno A., Cabezas-Mera F., Tejera E., Machado A. Comparative effectiveness of treatments for bacterial vaginosis: a network meta-analysis. Antibiotics (Basel). 2021;10(8):978. DOI: 10.3390/antibiotics10080978.
34. Instructions for use of the biologically active additive Duogynal® (Electronic resource.) URL: https://www.vidal.ru/drugs/duogynal (access date: 11.09.2022) (in Russ.).
35. Todorov S.D., Furtado D.N., Saad S.M., Gombossy de Melo Franco B.D. Bacteriocin production and resistance to drugs are advantageous features for Lactobacillus acidophilus La-14, a potential probiotic strain. New Microbiol. 2011;34(4):357–370. PMID: 22143809.
36. Russo R., Karadja E., De Seta F. Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial. Benef Microbes. 2019;10(1):19–26. DOI: 10.3920/BM2018.0075.
37. Russo R., Superti F., Karadja E., De Seta F. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses. 2019;62(4):328–335. DOI: 10.1111/myc.12883.
38. Russo R., Edu A., De Seta F. Study on the effects of an oral lactobacilli and lactoferrin complex in women with intermediate vaginal microbiota. Arch Gynecol Obstet. 2018;298(1):139–145. DOI: 10.1007/s00404-018-4771-z.
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