Activity of hydrolytic enzymes in fungi isolated from diabetic pregnant women: Is there any relationship between fungal alkaline and acid phosphatase activity and glycemic control?

Abstract

Ability to respond to environmental changes and secretion of hydrolases are considered to be important for Candida virulence. In this study we determined and compared the activities of 19 different hydrolases of the fungal strains isolated from diabetic and non-diabetic pregnant women. We also looked for the presence of a relationship between hydrolase activities and glycemic control, and, furthermore, evaluated the influence of gestational age on the activity of hydrolases. Mycological examinations were performed for 119 diabetic pregnant women: 47 with diabetes mellitus type I (DM), 72 with gestational diabetes (GDM), and for 132 healthy women (CON). Samples were collected from the vagina, rectum and oral cavity and cultured on Sabouraud media. The fungal hydrolase activities were evaluated using the API ZYM test (bioMerieux). For the 19 different fungal hydrolases tested, 13 activities were present in the isolated fungal strains. The activity of alkaline phosphatase (ALP) in vaginal strains (p=0.028) and acid phosphatase (ACP) in strains from the vagina (p=0.006) and rectum (p=0.049) was significantly lower in DM than in GDM and CON women. In conclusion, we describe for the first time that fungi isolated from pregnant diabetic women have lower activity of both phosphatases compared to fungi isolated from healthy women. Furthermore, similar differences of mean ALP and ACP activities were observed in the course of pregnancy in strains from the vagina and rectum of DM and CON women. However, strains from DM had lower activity at each stage of pregnancy. The highest activity of ALP and ACP was detected at the beginning, then declined, and had the lowest values between the 24(th) and 33(rd) week of gestation. After that period the activity of both phosphatases increased.

Association of gestational diabetes mellitus and abnormal vaginal flora with adverse pregnancy outcomes

“…[ 39 ] During pregnancy, elevated hormone levels and glycogen accumulation in the vagina lead to a rise in VVC frequency, about 2 folds compared with nonpregnant women. [ 23 , 24 , 29 – 31 , 40 ] It is generally believed that pregnant women with GDM are predisposed to Candida colonization of the vagina. [ 25 – 28 ] Elevated glycemia in the vaginal tissue increases fungus adhesion and growth, predisposing the vaginal epithelial cells to binding to Candida albicans cells.…”

“…[ 25 – 28 ] Elevated glycemia in the vaginal tissue increases fungus adhesion and growth, predisposing the vaginal epithelial cells to binding to Candida albicans cells. [ 23 , 24 ] In addition, glycemia of 10 to 11 mmol/L could impair host defense mechanism, and hyperglycemia decreases neutrophil nonpurposeful migration and weakens their chemotactic and phagocytic powers, thereby elevating diabetic patient's sensitivity to VVC. [ 23 , 24 ]…”

“…[ 18 ] In itself, vaginal infection can be a cause of intrauterine infections, stillbirth, premature delivery, and neurological damage to the fetus. [ 19 – 22 ] Since GDM is associated with poor metabolic control, higher body mass index, and impaired leukocyte function, [ 23 , 24 ] some studies have suggested that GDM is associated with disturbances in the vaginal flora and vagina infections, [ 25 – 30 ] but this is controversial. [ 31 ] Infections caused by Candida are relatively well known to be associated with GDM, [ 25 – 28 ] but much less is known about bacterial infections.…”

Risk of Vaginal Infections at Early Gestation in Patients with Diabetic Conditions during Pregnancy: A Retrospective Cohort Study

“…Concerning bacterial vaginosis even less evidence is available for women with GDM. On the one hand, it appears logically consistent that diabetic pregnant women more likely acquire genital infections, because of poor metabolic control, higher body mass index (BMI) and potentially impaired leucocyte function [ 15 , 16 ]. Moreover, pregnancy itself harbours an immunocompromised state, leading to an increased risk of vaginal Candida colonization [ 17 ].…”

ORIGINAL ARTICLE: Evaluation of Semen Detection in Vaginal Secretions: Comparison of Four Methods

“…reported that PSA levels prior to inoculation were very low, increased dramatically after inoculation and showed a strong dose response such that increasing amounts of semen yielded increased amounts of PSA. Another shortcoming of the use of AP was described by Nowakowska and colleagues 25 . In this report, vaginal fungi were shown to release AP; thus, the presence of a fungal vaginal infection could produce erroneous assessment of the presence of semen.…”