Microbiota y perfil inmunológico vaginal de la embarazada propensa a parto prematuro por infección bacteriana ascendente: revisión narrativa / Microbiota and vaginal immunological profile of pregnant women prone to premature birth due to ascending bacterial infection: narrative review

El parto prematuro (PP) es la principal causa de morbilidad/mortalidad perinatal en el mundo. La infección intrauterina es el origen más frecuente del PP espontáneo (PPE) en un hospital público de Chile. Existe evidencia de que la infección bacteriana ascendente (IBA) produce la infección/inflamación intraamniótica, el PPE y los resultados adversos maternos y perinatales. Esta revisión narrativa incluye revisiones sistemáticas y estudios de cohorte o de caso-control sobre la microbiota y el perfil inmunológico existente en el tracto genital inferior (TGI) de la embarazada propensa a PPE por IBA. Existe consenso en que en la microbiota del TGI de esta gestante hay colonización vaginal con baja abundancia de lactobacilos y/o disminución de su calidad, por diferencias raciales y/o geográficas o genéticas y una desregulación de los mecanismos inmunológicos del TGI. Estas respuestas se presentan con mayor intensidad en pacientes con factores de riesgo del huésped, como diabetes, obesidad, estrés, ansiedad y depresión, originando infecciones recurrentes del TGI, responsables del PPE y de los resultados perinatales. El conocimiento del comportamiento de la microbiota y del sistema inmunitario en estos casos permitirá tener terapias eficaces para prevenir el PPE y la morbilidad/mortalidad neonatal por IBA.

Preterm delivery (PD) is the leading cause of perinatal morbidity/mortality in the world. Intrauterine infection is the most frequent origin of spontaneous PD (SPD) in a public hospital in Chile. There is evidence that vaginal ascending bacterial infection (ABI) causes intra-amniotic infection/inflammation, SPD, and adverse maternal and perinatal outcomes. This narrative review includes systematic reviews and cohort or case-control studies on the microbiota and immunological profile existing in the lower genital tract (LGT) of pregnant women prone to SPD due to ABI. There is consensus that in the LGT microbiota of this pregnant woman there is vaginal colonization with low abundance of Lactobacilli and/or decreased quality, due to racial and/or geographic, or genetic differences and dysregulation of immunological mechanisms of the LGT. These responses occur with greater intensity in patients with host risk factors, such as diabetes, obesity, stress, anxiety, and depression, causing recurrent LGT infections responsible for SPD and perinatal outcomes. Knowledge of the behavior of the microbiota and the immune system in these cases will allow effective therapies to prevent SPD and neonatal morbidity/mortality due to ABI.

Extract of Sophorae flavescentis radix-Cnidii fructus couplet medicines treats vulvovaginal candidiasis by affecting the vaginal mucosal barrier.

Aim: This study investigated the inhibition of extract of Sophorae flavescentis radix-Cnidii fructus couplet medicines (ESCC) on Candida albicans (C. albicans) in vitro and the effect of ESCC on the vaginal mucosal barrier in vivo. Materials & methods: Susceptibility testing was performed with C. albicans SC5314. A vulvovaginal candidiasis mouse model was successfully established. The plate method, Gram staining, hematoxylin and eosin staining and ELISA were used to detect relevant inflammatory indexes: IFN-γ, IL-1 and TNF-α. Quantitative real-time PCR and western blot were used to detect mucosal immune-related factors: MUC1, MUC4, DEFB1 and DEFB2. Results: ESCC was able to inhibit the proliferative activity of C. albicans, and it affected inflammation-related factors and indicators of vaginal mucosal immunity. Conclusion: ESCC showed potential value in the treatment of vulvovaginal candidiasis.

Correlations between Specific and Nonspecific Vaginal Immunity in Women with Breast Cancer in Kazakhstan.

Background: The most common malignant tumor in women is breast cancer (BC). The ability of regulatory cells to inhibit cellular immune response as well as to participate in the modulation of antitumor immunity has attracted much interest of scientists. The purpose of this study was to assess the correlation between the specific and nonspecific vaginal immunity in women with BC. Methods: This was an experimental study. The study involved 278 women, 174 of whom received chemotherapy. The sampling was performed using a universal probe. The qualitative and quantitative assessment of the vaginal microflora was done using the polymerase chain reaction method. Statistical processing of the analysis was performed using the Statistica 10.0 licensed software. The parameters of the immune status before and after chemotherapy were analyzed, and the correlation between the number of cells in the main populations of lymphocytes before and after chemotherapy was investigated. Results: The study of the correlation between the number of cells of the main lymphocyte populations before and after chemotherapy showed an inhibition of B-lymphocytes (CD3-CD19+) in the study group, as the subpopulations of T-cytotoxic (CD4-CD8+) and CD3+HLA-DR+ (activated E-lymphocytes) were increased in both groups. Direct correlations were observed between local vaginal immunity and the immune status of the examined women in the study group between Megasphaera spp. and Enterobacteriaceae, with a certain population of immunocompetent cells. Conclusion: It was concluded that impaired biocenosis and suppression of local immune responses in women with BC were the reason for the active involvement of the components of the immune system.