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REVIEW article

Front. Microbiomes
Sec. Host and Microbe Associations
Volume 3 - 2024 | doi: 10.3389/frmbi.2024.1363089
This article is part of the Research Topic Live Biotherapeutic Products: Where Are We? View all 5 articles

Vaginal Dysbiosis and the Potential of Vaginal Microbiome-Directed Therapeutics

Provisionally accepted
Valerie Diane Valeriano Valerie Diane Valeriano 1Emilia Lahtinen Emilia Lahtinen 1In Chan Hwang In Chan Hwang 1Yichan Zhang Yichan Zhang 1Juan Du Juan Du 1Ina Schuppe Koistinen Ina Schuppe Koistinen 1,2*
  • 1 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
  • 2 Karolinska Institutet (KI), Solna, Sweden

The final, formatted version of the article will be published soon.

    A healthy vaginal microbiome (VMB) is dominated by Lactobacillus spp. and provides the first line of defense against invading pathogens. Vaginal dysbiosis, characterized by the loss of Lactobacillus dominance and increase of microbial diversity, has been linked to an increased risk of adverse genital tract diseases, including bacterial vaginosis, aerobic vaginitis, vulvovaginal candidiasis, sexually transmitted infections, and pregnancy complications such as preterm birth. Currently, antibiotics and antifungals are recommended first-line treatments with high cure rates, but they also can lead to high recurrence and resistance development. As an alternative, lactobacilli have been utilized to restore the vaginal microbiota.In this review article, we discuss vaginal dysbiosis in various gynecological infections and potential interventions based on Live Biotherapeutic Products (LBPs) with a focus on those that use intravaginal treatment modalities to modulate the VMB. Based on these, we provide insights on key factors to consider in designing phenotypic and genotypic screens for selecting bacterial strains for use as vaginally administered microbiome-directed therapeutics. Lastly, to highlight current progress within this field, we provide an overview of LBPs currently being developed with published clinical trial completion for recurrent BV, VVC, and UTI. We also discuss regulatory challenges in the drug development process to harmonize future research efforts in VMB therapy.

    Keywords: Dysbiosis, vaginal microbiome, VAGINAL HEALTH, live biopharmaceutical products, lactobacilli

    Received: 29 Dec 2023; Accepted: 16 Sep 2024.

    Copyright: © 2024 Valeriano, Lahtinen, Hwang, Zhang, Du and Schuppe Koistinen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ina Schuppe Koistinen, Karolinska Institutet (KI), Solna, Sweden

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.