The microbiome and endometriosis

Miyashira, Carlos H; Oliveira, Fernanda Reali; Andres, Marina Paula; Gingold, Julian A.; Abrão, Maurício Simões

doi:10.1530/raf-21-0113

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…Lactobacillus ASV, the most abundant bacteria found in vaginal and endometrium samples, was shared independently of the infertility condition. In contrast, Gardnerella was found in the FRT samples for all patients but shared ASV distributed differently for other conditions associated with infertility while being site-specific for patients with endometriosis [51,57]. One of the most relevant results of this study is the presence of Haemophilus in oral samples from patients with endometriosis.…”

Section: Discussionmentioning

confidence: 56%

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Distinct Gastrointestinal and Reproductive Microbial Patterns in Female Holobiont of Infertility

Marcos,

Rus,

Areal-Quecuty

et al. 2024

Microorganisms

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The microbiota is in symbiosis with the human body as a holobiont. Infertility conditions affect the female reproductive tract (FRT) and its resident microbiota. However, a disturbance in homeostasis could influence the FRT and other distal body sites, such as the gastrointestinal tract (GIT). We included 21 patients with endometriosis and other infertility-associated diseases with clinical profiles and biological samples from the FRT (endometrium, endometrial fluid, and vagina), and GIT samples (oral and feces). We performed a 16S rRNA analysis of site-specific microbial communities and estimated diversity metrics. The study found body site-specific microbial patterns in the FRT–GIT. In both study groups, Lactobacillus was the most shared Amplicon Sequence Variant (ASV), a precise identifier of microbial sequences, between endometrial and vagina samples. However, shared Gardnerella and Enterobacteriaceae ASVs were linked to other conditions but not endometriosis. Remarkably, Haemophilus was a specific GIT-shared taxon in endometriosis cases. In conclusion, infertility influences distinctly the FRT and GIT microbiomes, with endometriosis showing unique microbial characteristics. We proposed the concept of ‘female holobiont’ as a community that comprises the host and microbes that must maintain overall homeostasis across all body sites to ensure a woman’s health. Insights into these microbial patterns not only advance our understanding of the pathophysiology of infertility but also open new avenues for developing microbe-based therapeutic interventions aimed at restoring microbial balance, thereby enhancing fertility prospects.

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Section: Discussionmentioning

confidence: 56%

“…On the contrary, numerous studies linked Lactobacillus to a healthy status [48][49][50]. The microbial profile could change depending on the endometriosis stage, where the early stages preserve the Lactobacillus populations, while the later stages were more diverse [51]. Wessels and Cols.…”

Section: Discussionmentioning

confidence: 99%

Distinct Gastrointestinal and Reproductive Microbial Patterns in Female Holobiont of Infertility

Marcos,

Rus,

Areal-Quecuty

et al. 2024

Microorganisms

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“…Furthermore, it has been demonstrated that the complex interplay among bacteria and the host epithelial and immune cells within the female reproductive tract is crucial for preserving the homeostasis of the reproductive system, and that a shift in their equilibrium can potentially contribute to a wide range of conditions 28,53–55 . Even if healthy women may exhibit diverse vaginal microbial compositions, 56 eubiotic vaginal microbiota is normally associated with low bacterial diversity and the dominance of Lactobacillus spp 57 .…”

Section: Discussionmentioning

confidence: 99%

“…28,49 Taxa from the order Rhodospirillales are Furthermore, it has been demonstrated that the complex interplay among bacteria and the host epithelial and immune cells within the female reproductive tract is crucial for preserving the homeostasis of the reproductive system, and that a shift in their equilibrium can potentially contribute to a wide range of conditions. 28,[53][54][55] Even if healthy women may exhibit diverse vaginal microbial compositions, 56 eubiotic vaginal microbiota is normally associated with low bacterial diversity and the dominance of Lactobacillus spp. 57 Despite having been less studied to date, the uterine microbiota in healthy women is characterized by an abundance of genus Lactobacillus, genus Gardnerella and phyla Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria.…”

Section: F I G U R E 5 Boxplots Representing Differences In Bray-curt...mentioning

confidence: 99%

Comparative analysis of endometrial, vaginal, and gut microbiota in patients with and without adenomyosis

Valdés‐Bango,

Gracia,

Rubio

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionAlterations in microbiota composition have been implicated in a variety of human diseases. Patients with adenomyosis present immune dysregulation leading to a persistent chronic inflammatory response. In this context, the hypothesis that alterations in the microbiota may be involved in the pathogenesis of adenomyosis, by affecting the epigenetic, immunologic, and biochemical functions of the host, has recently been postulated. The aim of the present study was to compare the microbiota composition in the vagina, endometrium, and gut of individuals with and without adenomyosis.Material and MethodsCross‐sectional study including 38 adenomyosis patients and 46 controls, performed between September 2021 and October 2022 in a university hospital‐based research center. The diagnosis of adenomyosis was based on sonographic criteria. Fecal, vaginal, and endometrial samples were collected. Study of the microbiota using 16S rRNA gene sequencing.ResultsPatients with adenomyosis exhibited a significant reduction in the gut microbial alpha diversity compared with healthy controls (Chao1 p = 0.012, Fisher p = 0.005, Observed species p = 0.005). Beta‐diversity analysis showed significant differences in the compositions of both gut and vaginal microbiota between adenomyosis patients and the control group (Adonis p‐value = 0.001; R2 = 0.03 and Adonis p‐value = 0.034; R2 = 0.04 respectively). Specific bacterial taxa were found to be either overrepresented (Rhodospirillales, Ruminococcus gauvreauii group, Ruminococcaceae, and Actinomyces) or underrepresented in the gut and endometrial microbiota of adenomyosis patients compared with controls. Distinct microbiota profiles were identified among patients with internal and external adenomyosis phenotypes.ConclusionsThe study revealed reduced gut microbiota diversity in adenomyosis patients, accompanied by distinct compositions in gut and vaginal microbiota compared with controls. Overrepresented or underrepresented bacterial taxa were noted in the gut and endometrial microbiota of adenomyosis patients, with variations in microbiota profiles among those with internal and external adenomyosis phenotypes. These findings suggest a potential association between microbiota and adenomyosis, indicating the need for further research to comprehensively understand the implications of these differences.

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“…CA-125 values were used along with the relative abundance of C. disporicum and L. reuteri as a diagnostic tool to differentiate from patients with CPP and no endometriosis, reporting a sensitivity of 89.19% but a specificity of 52.0% [ 27 ]. Other studies have found vaginal L. jensenii to be decreased in patients with CPP-Endo or increased in early-stage endometriosis [ 28 ]. Therefore, further research is needed to conclude the association of vaginal Lactobacillus with the presence, location, and stage of endometriosis and other factors that may confound these studies.…”

Section: Discussionmentioning

confidence: 99%

Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

Jimenez,

Norton,

Diadala

et al. 2024

BMC Med

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Background Chronic pelvic pain (CPP) is a multifactorial syndrome that can substantially affect a patient’s quality of life. Endometriosis is one cause of CPP, and alterations of the immune and microbiome profiles have been observed in patients with endometriosis. The objective of this pilot study was to investigate differences in the vaginal and gastrointestinal microbiomes and cervicovaginal immune microenvironment in patients with CPP and endometriosis diagnosis compared to those with CPP without endometriosis and no CPP. Methods Vaginal swabs, rectal swabs, and cervicovaginal lavages (CVL) were collected among individuals undergoing gynecologic laparoscopy. Participants were grouped based on patients seeking care for chronic pain and/or pathology results: CPP and endometriosis (CPP-Endo) (n = 35), CPP without endometriosis (n = 23), or patients without CPP or endometriosis (controls) (n = 15). Sensitivity analyses were performed on CPP with endometriosis location, stage, and co-occurring gynecologic conditions (abnormal uterine bleeding, fibroids). 16S rRNA sequencing was performed to profile the microbiome, and a panel of soluble immune mediators was quantified using a multiplex assay. Statistical analysis was conducted with SAS, R, MicrobiomeAnalyst, MetaboAnalyst, and QIIME 2. Results Significant differences were observed between participants with CPP alone, CPP-Endo, and surgical controls for body mass index, ethnicity, diagnosis of ovarian cysts, and diagnosis of fibroids. In rectal microbiome analysis, both CPP alone and CPP-Endo exhibited lower alpha diversity than controls, and both CPP groups revealed enrichment of irritable bowel syndrome-associated bacteria. CPP-Endo exhibited an increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus. Patients with CPP and endometrioma (s) demonstrated increased vaginal Streptococcus, Lactobacillus, and Prevotella compared to other endometriosis sites. Further, abnormal uterine bleeding was associated with an increased abundance of bacterial vaginosis-associated bacteria. Immunoproteomic profiles were distinctly clustered by CPP alone and CPP-Endo compared to controls. CPP-Endo was enriched in TNF⍺, MDC, and IL-1⍺. Conclusions Vaginal and rectal microbiomes were observed to differ between patients with CPP alone and CPP with endometriosis, which may be useful in personalized treatment for individuals with CPP and endometriosis from those with other causes of CPP. Further investigation is warranted in patients with additional co-occurring conditions, such as AUB/fibroids, which add additional complexity to these conditions and reveal the enrichment of distinct pathogenic bacteria in both mucosal sites. This study provides foundational microbiome-immunoproteomic knowledge related to chronic pelvic pain, endometriosis, and co-occurring gynecologic conditions that can help improve the treatment of patients seeking care for pain.

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The microbiome and endometriosis

Cited by 6 publications

References 31 publications

Distinct Gastrointestinal and Reproductive Microbial Patterns in Female Holobiont of Infertility

Distinct Gastrointestinal and Reproductive Microbial Patterns in Female Holobiont of Infertility

Comparative analysis of endometrial, vaginal, and gut microbiota in patients with and without adenomyosis

Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

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