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The role of probiotics in the treatment of adult atopic dermatitis: a meta-analysis of randomized controlled trials.
Umborowati, MA, Damayanti, D, Anggraeni, S, Endaryanto, A, Surono, IS, Effendy, I, Prakoeswa, CRS
Journal of health, population, and nutrition. 2022;41(1):37
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Allergic diseases, including atopic dermatitis (AD), are serious conditions that disrupt the quality of life of affected individuals. AD is a chronic inflammatory skin disease that is relapsing and whose onset is generally related to a patient’s or family’s atopic history such as asthma and allergic rhinitis. The aim of this study was to assess randomized control trials based on the PICO strategy—population = adult with AD; intervention = probiotic intervention; control = standard therapy; and outcome = clinical manifestations (Scoring Atopic Dermatitis index (SCORAD) evaluation, skin severity, itch severity), quality of life, and/or immune response. This study is a systematic review of six randomised controlled trials involving a total of 241 subjects, including 128 subjects in the probiotics group and 113 subjects in the placebo group. Results show that probiotic supplementation may have the potential to decrease disease severity (SCORAD) in adult AD. Therefore, decrease in disease severity may also improve the quality of life. Authors conclude that based on their findings, probiotics can be used as adjuvant treatment of adult AD.
Abstract
BACKGROUND Atopic dermatitis (AD) is chronic inflammatory skin disease that is relapsing and a serious condition that disrupts the quality of life of affected individuals. Probiotics are an immunomodulator that can enhance the immune control of atopic dermatitis. METHODS All randomized controlled trials of probiotics for the treatment of adult AD published before December 2020 were included in this study from the PubMed databases and manual searching. RESULTS Six randomized controlled trials (n = 241) were selected for this meta-analysis study. Probiotics were effective in treating adult patients with AD, indicated by the decrease in Scoring Atopic Dermatitis/SCORAD (Mean Difference (MD) - 7.90, 95% CI - 7.25 to - 6.92; p < 0.00001; I2 = 96%) and improved quality of life (MD - 7.68, 95% CI - 14.08 to - 1.29; p = 0.02; I2 = 47%) which were statistically significant. However, skin severity, itch severity, Dermatology Life Quality Index (DLQI), IL-4, TFN-γ, and IgE showed no significant difference in this meta-analysis study (p > 0.05). LIMITATIONS The study found no available data for side effects of probiotics. STRENGTH This meta-analysis analyzed a total of 241 AD patients of Asian and European origin. CONCLUSION The use of probiotics decreased SCORAD significantly in adult patients with AD. Probiotics can improve the quality of life of patients with AD. The use of probiotics in atopic dermatitis has been widely studied, with controversial results. This meta-analysis suggests that the use of probiotics can improve SCORAD and the quality of life of patients with atopic dermatitis.
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Interaction of cervical microbiome with epigenome of epithelial cells: Significance of inflammation to primary healthcare.
Holubekova, V, Kolkova, Z, Kasubova, I, Samec, M, Mazurakova, A, Koklesova, L, Kubatka, P, Rokos, T, Kozubik, E, Biringer, K, et al
Biomolecular concepts. 2022;13(1):61-80
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A female health is one medical area of the framework strategies in predictive, preventive, and personalized (3P) medicine. Cervical cancer is preventable and successfully treatable at early stages that makes the disease as an ideal candidate applicable in the context of 3P medicine. The aim of this study was to examine the interaction of the cervical microbiome with epithelial cells in relation to inflammation, and to assess direct evidence of epigenetic changes related to the cervical microbiome. This study is a systematic review of publications in the field of cervical cancer research. This review shows that: - cervical cancer screening in future integration of precision cancer prevention regimes should match an individual’s risk of cancer in context with genomic and environmental factors. - identification of microbiome population might be one of the key aspects of precision medicine in the future. Microbial composition may early identify the potential risk of precancerous lesion formation or permanent bacterial vaginosis. - the composition of the microbiome can be influenced by dietary composition, which will also affect the epigenetic background of the microbiome. However, food forms the microbiome through epigenetic mechanisms, and it is thus necessary to clarify how cancer risk is increased due to food-related microbially produced metabolites. - an examination of the metabolites during inflammation of the cervical epithelium and bacterial vaginosis may improve the precise identification of inflammatory-induced biomarkers that could aid in the precision medicine in prediction of the risk of cervical dysplasia development. - cancer-associated inflammation pathways can be influenced by phytochemicals with anti-inflammatory effects on immune cells, suppression of proinflammatory transcription factors, cytokines, and chemokines. The biological balance between uncontrolled chronic inflammation and controlled inflammation is essential for cancer prevention, prediction, and prognostication. Authors conclude that their review highlighted the pivotal contribution of cervical microbiome, epigenetic changes, and inflammation to the formation of cervical intraepithelial lesion and progression to cervical cancer.
Abstract
One pillar of the predictive, preventive, and personalized medicine framework strategies is the female health. The evaluation of women's lifestyle and dietary habits in context with genetic and modifiable risk factors may reflect the prevention of cervical cancer before the occurrence of clinical symptoms and prediction of cervical lesion behavior. The main aim of this review is to analyze publications in the field of precision medicine that allow the use of research knowledge of cervical microbiome, epigenetic modifications, and inflammation in potential application in clinical practice. Personalized approach in evaluating patient's risk of future development of cervical abnormality should consider the biomarkers of the local microenvironment characterized by the microbial composition, epigenetic pattern of cervical epithelium, and presence of chronic inflammation. Novel sequencing techniques enable a more detailed characterization of actual state in cervical epithelium. Better understanding of all changes in multiomics level enables a better assessment of disease prognosis and selects the eligible targeted therapy in personalized medicine. Restoring of healthy vaginal microflora and reversing the outbreak of cervical abnormality can be also achieved by dietary habits as well as uptake of prebiotics, probiotics, synbiotics, microbial transplantation, and others.
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SARS-CoV-2 and immune-microbiome interactions: Lessons from respiratory viral infections.
Cyprian, F, Sohail, MU, Abdelhafez, I, Salman, S, Attique, Z, Kamareddine, L, Al-Asmakh, M
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2021;105:540-550
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped RNA beta-coronavirus. This virus caused the coronavirus disease 2019 (COVID-19) pandemic. The aim of this review was to investigate the relationship between microbiota, immunity, and COVID-19, with particular focus on how microbiome-associated immune crosstalk can shape outcome of COVID-19. The study included 118 articles which investigated or reviewed COVID-19 or coronavirus and the microbiome of the gut or respiratory tract. Findings indicate that: - an over-activated immune system leads to massive pulmonary damage in COVID-19 patients. - the effect of aging and comorbidities, and the use of antibiotics have an effect on the diversity of the microbiota. - the milieu of gut flora can exert influence on pulmonary immune responses. - a unique cross-talk exists between the pulmonary and gut microbial compartments. Authors conclude by highlighting the need of further studies that delineate the role of the microbiota and their products in the immune dysregulation observed in SARS-CoV-2 infections.
Abstract
By the beginning of 2020, infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly evolved into an emergent worldwide pandemic, an outbreak whose unprecedented consequences highlighted many existing flaws within public healthcare systems across the world. While coronavirus disease 2019 (COVID-19) is bestowed with a broad spectrum of clinical manifestations, involving the vital organs, the respiratory system transpires as the main route of entry for SARS-CoV-2, with the lungs being its primary target. Of those infected, up to 20% require hospitalization on account of severity, while the majority of patients are either asymptomatic or exhibit mild symptoms. Exacerbation in the disease severity and complications of COVID-19 infection have been associated with multiple comorbidities, including hypertension, diabetes mellitus, cardiovascular disorders, cancer, and chronic lung disease. Interestingly, a recent body of evidence indicated the pulmonary and gut microbiomes as potential modulators for altering the course of COVID-19, potentially via the microbiome-immune system axis. While the relative concordance between microbes and immunity has yet to be fully elucidated with regards to COVID-19, we present an overview of our current understanding of COVID-19-microbiome-immune cross talk and discuss the potential contributions of microbiome-related immunity to SARS-CoV-2 pathogenesis and COVID-19 disease progression.
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Probiotics in Prevention and Treatment of COVID-19: Current Perspective and Future Prospects.
Kurian, SJ, Unnikrishnan, MK, Miraj, SS, Bagchi, D, Banerjee, M, Reddy, BS, Rodrigues, GS, Manu, MK, Saravu, K, Mukhopadhyay, C, et al
Archives of medical research. 2021;52(6):582-594
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The novel coronavirus pandemic of 2019 (COVID-19), an emerging infectious disease, is caused by multiple strains of Severe Acute Respiratory Syndrome Coronavirus-2. The main aim of this study was to outline the potential role of probiotics in fighting the COVID-19. This study focuses on recent evidence on the association between microbiota, probiotics, and COVID-19, the role of probiotics as an immune-modulator and antiviral agent. Findings support probiotics’ role in regulating the immune system, suggesting a definitive role for probiotics in viral infections. Thus, probiotics supplementation could reduce the severity of COVID-19 morbidity and mortality. Authors conclude that supplementation of probiotics in high risk and severely ill patients, and frontline health workers, may help to limit the infection and flatten the COVID-19 curve. However, further studies should be conducted for more conclusive evidence.
Abstract
Saving lives and flattening the curve are the foremost priorities during the ongoing pandemic spread of SARS-CoV-2. Developing cutting-edge technology and collating available evidence would support frontline health teams. Nutritional adequacy improves general health and immunity to prevent and assuage infections. This review aims to outline the potential role of probiotics in fighting the COVID-19 by covering recent evidence on the association between microbiota, probiotics, and COVID-19, the role of probiotics as an immune-modulator and antiviral agent. The high basic reproduction number (R0) of SARS-CoV-2, absence of conclusive remedies, and the pleiotropic effect of probiotics in fighting influenza and other coronaviruses together favour probiotics supplements. However, further support from preclinical and clinical studies and reviews outlining the role of probiotics in COVID-19 are critical. Results are awaited from many ongoing clinical trials investigating the benefits of probiotics in COVID-19.
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Effects of Microbiota Imbalance in Anxiety and Eating Disorders: Probiotics as Novel Therapeutic Approaches.
Navarro-Tapia, E, Almeida-Toledano, L, Sebastiani, G, Serra-Delgado, M, García-Algar, Ó, Andreu-Fernández, V
International journal of molecular sciences. 2021;22(5)
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The interest in mental health has increased recently. Anxiety and mood disorders are associated with many disabilities and there is a close relationship between eating disorders and anxiety. Although current medical treatments for anxiety disorders are safer than a few decades ago; the effectiveness in some of them has not improved, they have side effects and can cause addiction. Therefore, the development of new tools to restore mental health without the undesired effects is necessary. Recent studies indicate that patients with generalized anxiety or eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorders) show a specific gut microbiota profile, and this imbalance can be partially restored after a single or multi-strain probiotic supplementation. The purpose of this review is to look at the main microbial patterns seen in patients with generalized anxiety and/or eating disorders as well as the importance of probiotics as a preventive or a therapeutic tool in these pathologies. The studies reviewed showed an imbalance of microbial communities in patients with anxiety and with eating disorders. The effect of probiotics in reducing anxiety seems to be more effective the higher the baseline anxiety level of the individual. For eating disorders, the correction of dysbiosis may be associated with the physical and emotional well-being of these subjects. Further study of the intestinal microbiota will enable progress in the study of therapeutic approaches of these areas.
Abstract
Anxiety and eating disorders produce a physiological imbalance that triggers alterations in the abundance and composition of gut microbiota. Moreover, the gut-brain axis can be altered by several factors such as diet, lifestyle, infections, and antibiotic treatment. Diet alterations generate gut dysbiosis, which affects immune system responses, inflammation mechanisms, the intestinal permeability, as well as the production of short chain fatty acids and neurotransmitters by gut microbiota, which are essential to the correct function of neurological processes. Recent studies indicated that patients with generalized anxiety or eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorders) show a specific profile of gut microbiota, and this imbalance can be partially restored after a single or multi-strain probiotic supplementation. Following the PRISMA methodology, the current review addresses the main microbial signatures observed in patients with generalized anxiety and/or eating disorders as well as the importance of probiotics as a preventive or a therapeutic tool in these pathologies.
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Evolution of the Human Diet and Its Impact on Gut Microbiota, Immune Responses, and Brain Health.
González Olmo, BM, Butler, MJ, Barrientos, RM
Nutrients. 2021;13(1)
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One explanation for the increased prevalence in chronic disease and mental illness is from the evolutionary perspective. This suggests the rapid shift in diet towards processed foods in the past 200 years has not allowed for sufficient adaptation of the gut microbiome. The gut microbiome plays an important role in the digestive, immune and nervous systems via the gut-brain axis, and may be a key factor in modulating inflammation and disease. The aim of this review is to discuss how what we eat affects the immune system and impacts our brain health. The literature currently shows significant associations between the Western diet and its impact on the health of the gut microbiome and the brain. Increased intake of saturated fats, refined carbohydrates and sugar, coupled with a reduction in fiber, negatively impacts the digestive system and elicits an immune response. This response can lead to neuroinflammation, which is now found to be associated with deficits in learning and memory, as well as increased rates of neurodegenerative disease and depression. Based on the existing literature, the authors conclude the human gut microbiome has not had sufficient time to adapt to many modern foods, thus leading to inflammation and disease. The authors recommend that a diet composed of natural whole foods with minimal processing can help prevent and alleviate some of the burden caused by chronic disease, and suggest future studies focus on improving techniques to evaluate neuroinflammation in humans.
Abstract
The relatively rapid shift from consuming preagricultural wild foods for thousands of years, to consuming postindustrial semi-processed and ultra-processed foods endemic of the Western world less than 200 years ago did not allow for evolutionary adaptation of the commensal microbial species that inhabit the human gastrointestinal (GI) tract, and this has significantly impacted gut health. The human gut microbiota, the diverse and dynamic population of microbes, has been demonstrated to have extensive and important interactions with the digestive, immune, and nervous systems. Western diet-induced dysbiosis of the gut microbiota has been shown to negatively impact human digestive physiology, to have pathogenic effects on the immune system, and, in turn, cause exaggerated neuroinflammation. Given the tremendous amount of evidence linking neuroinflammation with neural dysfunction, it is no surprise that the Western diet has been implicated in the development of many diseases and disorders of the brain, including memory impairments, neurodegenerative disorders, and depression. In this review, we discuss each of these concepts to understand how what we eat can lead to cognitive and psychiatric diseases.
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Role of the Intestinal Microbiome, Intestinal Barrier and Psychobiotics in Depression.
Trzeciak, P, Herbet, M
Nutrients. 2021;13(3)
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Major depressive disorder (MDD) is a disorder with feelings of depressed mood or loss of interest or pleasure alongside several other symptoms such as weight or appetite changes, difficulty sleeping and an inability to think or concentrate. The development of MDD is not fully understood and may involve several different factors such as the gut microbiome. The gut microbiome may be involved as it can communicate with the brain in a bidirectional fashion, known as the gut-brain axis. This review study aimed to summarise the data on the use of probiotics thought to confer benefits in the brain, known as psychobiotics. Depression is thought to involve aspects of imbalances in brain signalling molecules, stress hormones, and free radicals and inflammation. One of the newest ideas suggests that the gut microbiome may have a role. Individuals with depression have shown to have altered composition of gut microbiota, which may have an impact in several ways. Alterations in vitamin production, altered intestinal barrier function and poor diet during disease, may all contribute to the development of MDD. Psychobiotics may be of benefit to symptoms of depression shown in numerous animal and human studies. It was concluded that there are several ways that the microbiota may be involved in the development of depression. This study could be used by healthcare professionals to justify the introduction of psychobiotics as an adjuvant to standard therapy for MDD, to relieve symptoms.
Abstract
The intestinal microbiota plays an important role in the pathophysiology of depression. As determined, the microbiota influences the shaping and modulation of the functioning of the gut-brain axis. The intestinal microbiota has a significant impact on processes related to neurotransmitter synthesis, the myelination of neurons in the prefrontal cortex, and is also involved in the development of the amygdala and hippocampus. Intestinal bacteria are also a source of vitamins, the deficiency of which is believed to be related to the response to antidepressant therapy and may lead to exacerbation of depressive symptoms. Additionally, it is known that, in periods of excessive activation of stress reactions, the immune system also plays an important role, negatively affecting the tightness of the intestinal barrier and intestinal microflora. In this review, we have summarized the role of the gut microbiota, its metabolites, and diet in susceptibility to depression. We also describe abnormalities in the functioning of the intestinal barrier caused by increased activity of the immune system in response to stressors. Moreover, the presented study discusses the role of psychobiotics in the prevention and treatment of depression through their influence on the intestinal barrier, immune processes, and functioning of the nervous system.
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The role of the microbiota-gut-brain axis in neuropsychiatric disorders.
Generoso, JS, Giridharan, VV, Lee, J, Macedo, D, Barichello, T
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2021;43(3):293-305
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Metabolites produced by the gut microbiota have been shown to influence mood and behaviour via the microbiota-gut-brain axis, and there is increased interest in better understanding this interaction in the context of mental health. This review summarises the evidence around the influence of gut microbiota in various neuropsychiatric disorders, primarily focusing on the metabolic pathways that originate in the gut microbiota. Current research highlights an association between gut microbiota metabolites with neuropsychiatric disorders and that probiotics demonstrate a significant therapeutic role in many of these disorders. Based on the current literature, the authors conclude it is crucial to better understand the complex microbiota-host interaction in health and disease, leading to more targeted and improved therapeutic interventions.
Abstract
The microbiota-gut-brain axis is a bidirectional signaling mechanism between the gastrointestinal tract and the central nervous system. The complexity of the intestinal ecosystem is extraordinary; it comprises more than 100 trillion microbial cells that inhabit the small and large intestine, and this interaction between microbiota and intestinal epithelium can cause physiological changes in the brain and influence mood and behavior. Currently, there has been an emphasis on how such interactions affect mental health. Evidence indicates that intestinal microbiota are involved in neurological and psychiatric disorders. This review covers evidence for the influence of gut microbiota on the brain and behavior in Alzheimer disease, dementia, anxiety, autism spectrum disorder, bipolar disorder, major depressive disorder, Parkinson's disease, and schizophrenia. The primary focus is on the pathways involved in intestinal metabolites of microbial origin, including short-chain fatty acids, tryptophan metabolites, and bacterial components that can activate the host's immune system. We also list clinical evidence regarding prebiotics, probiotics, and fecal microbiota transplantation as adjuvant therapies for neuropsychiatric disorders.
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The Human Vulvar Microbiome: A Systematic Review.
Pagan, L, Ederveen, RAM, Huisman, BW, Schoones, JW, Zwittink, RD, Schuren, FHJ, Rissmann, R, Piek, JMJ, van Poelgeest, MIE
Microorganisms. 2021;9(12)
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Vaginal microbiome composition and its link with cancer is an emerging area in research. Imbalances in the vaginal microbiome could initiate carcinogenesis by altering immunity and metabolism and accelerating inflammation. This systematic review included ten studies and assessed the vulvar microbiome in premalignant vulvar disease and healthy vulvar skin. The healthy vulvar skin showed several bacterial taxa of Lactobacillus, Corynebacterium, Staphylococcus and Prevotella of intestinal, cutaneous and vaginal origin. L. crispatus and L. iners were dominant on the vulva of most healthy women. L. gasseri dominance was non-significantly associated with vestibulodynia. Menstruation did not alter the bacterial composition. Premenarchial Lichen sclerosus may have an association with microbial dysbiosis. Further robust studies are required to identify the vaginal microbial composition due to the high heterogeneity of the studies included, small sample size and methodological limitations. Healthcare professionals can utilise the data from this study to better understand how the vulvar microbiome influences disease aetiology and its importance as a target for therapy.
Abstract
The link between cancer and the microbiome is a fast-moving field in research. There is little knowledge on the microbiome in ((pre)malignant) conditions of the vulvar skin. This systematic review aims to provide an overview of the literature regarding the microbiome composition of the healthy vulvar skin and in (pre)malignant vulvar disease. This study was performed according to the PRISMA guidelines. A comprehensive, electronic search strategy was used to identify original research articles (updated September 2021). The inclusion criteria were articles using culture-independent methods for microbiome profiling of the vulvar region. Ten articles were included. The bacterial composition of the vulva consists of several genera including Lactobacillus, Corynebacterium, Staphylococcus and Prevotella, suggesting that the vulvar microbiome composition shows similarities with the corresponding vaginal milieu. However, the vulvar microbiome generally displayed higher diversity with commensals of cutaneous and fecal origin. This is the first systematic review that investigates the relationship between microbiome and vulvar (pre)malignant disease. There are limited data and the level of evidence is low with limitations in study size, population diversity and methodology. Nevertheless, the vulvar microbiome represents a promising field for exploring potential links for disease etiology and targets for therapy.
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Contribution of Lactobacillus iners to Vaginal Health and Diseases: A Systematic Review.
Zheng, N, Guo, R, Wang, J, Zhou, W, Ling, Z
Frontiers in cellular and infection microbiology. 2021;11:792787
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The vaginal microbiome is an important contributor to vaginal health. Here the dominance of Lactobacilli species, alongside their antimicrobial compounds play a critical role in contributing and protecting the vaginal milieu. Conversely the disruption or absence of Lactobacilli dominance is frequently associated with vaginal disease and infections. One of the Lactobacilli species prevalent in the vaginal microbiome is Lactobacillus iners. It was long overlooked in research due to it being so difficult to culture, and it was first identified in 1999 thanks to DNA sequencing. Researchers since discovered that the relationship between L. iners and vaginal health is far more complicated and ambiguous compared to the other Lactobacilli species. This systematic review explores the current knowledge of the characteristics of L. iners and its role in vaginal health and disease. The article discusses L. iners identification, genetic make up and differences to other Lactobacilli species and how they relate to vaginal health. The article also summarizes L. iners nutrient requirements and its role in diseases like dysbiosis, bacterial vaginosis, sexually transmitted infections and biofilm formation. Furthermore the authors look at the relation between L. iners and premature birthing, fertility and menstrual cycles. A final section in discusses the antimicrobial and immune sytem activating qualities of L. iners. In light of all these findings the authors describe L . iners as a very unique Lactobacilli due to its unusual characteristics. Whether L. iners is beneficial or pathogenic for the host remains controversial, as it can adapt to high and low pH environment and is seen in health and equally dysbiotic states of infection. Hence some describe it as a transitional species that colonizes the vagina after disturbances. It may be a risk factor for infections by contributing to the onset and maintenance of dysbiotic disturbances. Further studies are needed to clarify the role of L. iners and its role on vaginal health and whether it could serve as a biomarker for vaginal inflammation. This article is a useful summary about the characteristics and role of L. iners in vaginal health in disease.
Abstract
Lactobacillus iners, first described in 1999, is a prevalent bacterial species of the vaginal microbiome. As L. iners does not easily grow on de Man-Rogosa-Sharpe agar, but can grow anaerobically on blood agar, it has been initially overlooked by traditional culture methods. It was not until the wide application of molecular biology techniques that the function of L. iners in the vaginal microbiome was carefully explored. L. iners has the smallest genome among known Lactobacilli and it has many probiotic characteristics, but is partly different from other major vaginal Lactobacillus species, such as L. crispatus, in contributing to the maintenance of a healthy vaginal microbiome. It is not only commonly present in the healthy vagina but quite often recovered in high numbers in bacterial vaginosis (BV). Increasing evidence suggests that L. iners is a transitional species that colonizes after the vaginal environment is disturbed and offers overall less protection against vaginal dysbiosis and, subsequently, leads to BV, sexually transmitted infections, and adverse pregnancy outcomes. Accordingly, under certain conditions, L. iners is a genuine vaginal symbiont, but it also seems to be an opportunistic pathogen. Further studies are necessary to identify the exact role of this intriguing species in vaginal health and diseases.