■阴道菌群失调包括阴道微生物群的失衡,通过改变细菌的组成来定义,病毒,和真菌,并与整倍体妊娠损失有关,早产,不孕症,或者细菌性阴道病.大部分患有阴道菌群失调的女性没有任何症状。抗生素是传统的治疗方法,最近在某些情况下与当地益生菌结合。在5例患者的案例研究中,成功进行了抗生素根除病原体后使用优生阴道细菌微生物群的阴道微生物群移植(VMT)。但是没有使用抗生素的VMT。
■这是一个概念案例研究的证明。该患者在哥本哈根大学医院Hvidovre的RPL诊所被发现患有阴道菌群失调,丹麦2021年6月23日她被提供并接受以VMT的形式接受实验性治疗,作为富有同情心的用例。VMT是宫颈阴道分泌物(CVS)从具有乳杆菌优势的阴道微生物组的健康供体转移到具有生态失调性阴道微生物组的受体。CVS是例如的混合物,粘液,细菌,存在于阴道腔中的代谢物。对潜在的捐赠者进行了彻底的筛查,以确定是否没有性传播感染,通过体外微生物组竞争试验确定了本研究中特定患者最合适的供体样品。
■一名30岁的患者,有一次活产,有复杂的妊娠史,有两次死产和妊娠27周(2019年)的1个月妊娠流产,17(2020)和23(2020)分别抱怨阴道刺激和分泌物在她的所有怀孕中都加重了。她的阴道微生物组组成显示了加德纳菌属的90%优势。一次VMT后,微生物组组成完全转移至81.2%的crispatus乳杆菌和9%的jensenii乳杆菌,并同时解决了阴道症状。单核苷酸多态性分析证实她的微生物组是供体来源的,并且在VMT后1.5年保持稳定。VMT后五个月,她怀孕了,并在足月成功分娩了一个健康的婴儿。
■在这里,我们报告了成功的VMT,并确认了供体菌株植入,然后在一系列晚期妊娠丢失/死胎后成功妊娠和分娩。研究结果表明,VMT是严重阴道菌群失调的潜在治疗方法。Further,需要更大的研究。
■这项研究得到了部分资助(即,分析成本)由FreyaBiosciencesAps,Fruebjergvej,2100哥本哈根,丹麦。
UNASSIGNED: Vaginal dysbiosis covers imbalances in the vaginal microbiota, defined by altered composition of bacteria, viruses, and fungi and is associated with euploid pregnancy losses, premature birth, infertility, or bacterial vaginosis. A large proportion of women who have vaginal dysbiosis do not experience any symptoms. Antibiotics are the traditional treatment, recently combined with local probiotics in some cases. Vaginal Microbiota Transplantation (VMT) with eubiotic vaginal bacterial microbiota after antibiotic eradication of pathogens has successfully been performed in a
case study with five patients, but no VMT has been performed without the use of antibiotics.
UNASSIGNED: This is a proof of concept
case study. The patient was found to have vaginal dysbiosis at the RPL clinic at Copenhagen University Hospital Hvidovre, Denmark on the 23rd of June 2021. She was offered and accepted to receive experimental treatment in the form of a VMT as a compassionate use
case. VMT is the transfer of cervicovaginal secretions (CVS) from a healthy donor with a Lactobacillus-dominant vaginal microbiome to a recipient with a dysbiotic vaginal microbiome. CVS is a mixture of e.g., mucus, bacteria, metabolites present in the vaginal canal. Potential donors were thoroughly screened for the absence of STIs, and the most suitable donor sample for the specific patient in this study was determined via an in vitro microbiome competition assay.
UNASSIGNED: A 30-year-old patient with one livebirth and a complicated pregnancy history of two stillbirths and 1 s trimester pregnancy loss in gestational weeks 27 (2019), 17 (2020) and 23 (2020) respectively with complaints of vaginal irritation and discharge that had aggravated in all her pregnancies. Her vaginal microbiome composition showed a 90% dominance of Gardnerella spp. After one VMT there was a complete shift in microbiome composition to 81.2% L. crispatus and 9% L. jensenii with a concurrent resolvement of vaginal symptoms. Single nucleotide polymorphism-analysis confirmed her microbiome to be of donor origin and it remain stable now 1.5 years after the VMT. Five months after the VMT she became pregnant and has successfully delivered a healthy baby at term.
UNASSIGNED: Here we report a successful VMT with confirmed donor strain engraftment followed by a successful pregnancy and delivery after a series of late pregnancy losses/stillbirths. Findings suggest that VMT is a potential treatment for severe vaginal dysbiosis. Further, larger studies are required.
UNASSIGNED: The study was partially funded (i.e., analysis costs) by Freya Biosciences Aps, Fruebjergvej, 2100 Copenhagen, Denmark.