Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.
Purchase
Buy instant access (PDF download and unlimited online access):
Institutional Login
Log in with Open Athens, Shibboleth, or your institutional credentials
Personal login
Log in with your brill.com account
Aballéa, S., Guelfucci, F., Wagner, J., Khemiri, A., Dietz, J.P., Sobel, J. and Toumi, M., 2013. Subjective health status and health-related quality of life among women with recurrent vulvovaginal candidosis (RVVC) in Europe and the USA. Health and Quality of Life Outcomes 11: 1-13. https://doi.org/10.1186/1477-7525-11-169
Anukam, K.C., Osazuwa, E., Osemene, G.I., Ehigiagbe, F., Bruce, A.W. and Reid, G., 2006. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes and Infection 8: 2772-2776. https://doi.org/10.1016/j.micinf.2006.08.008
Borges, S., Silva, J. and Teixeira, P., 2014. The role of lactobacilli and probiotics in maintaining vaginal health. Archives of Gynecology and Obstetrics 289: 479-489. https://doi.org/10.1007/s00404-013-3064-9
Czaja, C.A., Stapleton, A.E., Yarova-Yarovaya, Y. and Stamm, W.E., 2007. Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women. Infectious Diseases in Obstetrics and Gynecology 2007: 35387. https://doi.org/10.1155/2007/35387
De Gregorio, P.R., Juárez Tomás, M., Santos, V. and Nader-Macías, M., 2012. Beneficial lactobacilli: effects on the vaginal tract in a murine experimental model. Antonie van Leeuwenhoek 102: 569-580. https://doi.org/10.1007/s10482-012-9752-9
De Gregorio, P.R., Juárez Tomás, M.S. and Nader-Macías, M.E.F., 2016. Immunomodulation of Lactobacillus reuteri CRL1324 on Group B Streptococcus vaginal colonization in a murine experimental model. American Journal of Reproductive Immunology 75: 23-35. https://doi.org/10.1111/aji.12445
De Gregorio, P.R., Juárez Tomás, M.S., Leccese Terraf, M.C. and Nader-Macías, M.E.F., 2014. In vitro and in vivo effects of beneficial vaginal lactobacilli on pathogens responsible for urogenital tract infections. Journal of Medical Microbiology 63: 685-696. https://doi.org/10.1099/jmm.0.069401-0
De Gregorio, P.R., Juárez Tomás, M.S., Leccese Terraf, M.C. and Nader-Macías, M.E.F., 2015. Preventive effect of Lactobacillus reuteri CRL1324 on Group B Streptococcus vaginal colonization in an experimental mouse model. Journal of Applied Microbiology 118: 1034-1047. https://doi.org/10.1111/jam.12739
De Gregorio, P.R., Silva, J.A., Marchesi, A. and Nader-Macías, M.E.F., 2019. Anti-Candida activity of beneficial vaginal lactobacilli in in vitro assays and in a murine experimental model. FEMS Yeast Research 19: foz008. https://doi.org/10.1093/femsyr/foz008
De Man, J., Rogosa, M. and Sharpe, M., 1960. A medium for the cultivation of lactobacilli. Journal of Applied Bacteriology 23: 130-135. https://doi.org/10.1111/j.1365-2672.1960.tb00188.x
Doyle, R.M., Harris, K., Kamiza, S., Harjunmaa, U., Ashorn, U., Nkhoma, M., Dewey, K.G., Maleta, K., Ashorn, P. and Klein, N., 2017. Bacterial communities found in placental tissues are associated with severe chorioamnionitis and adverse birth outcomes. PLoS ONE 12: e0180167.
'Bacterial communities found in placental tissues are associated with severe chorioamnionitis and adverse birth outcomes ' () 12 PLoS ONE : e0180167 -.
Drago, L., De Vecchi, V., Nicola, L., Zucchetti, E. and Vicariotto, F., 2007. Activity of a Lactobacillus acidophilus-based douche for the treatment of bacterial vaginosis. Journal of Alternative and Complementary Medicine 13: 435-438. https://doi.org/10.1089/acm.2006.6040
Ehrstro, S., Daroczy, K., Rylander, E., Samuelsson, C., Johannesson, U., Anzén, B. and Pahlson, C., 2010. Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis. Microbes and Infection 12: 691-699. https://doi.org/10.1016/j.micinf.2010.04.010
Food and Agriculture Organisation / World Health Organisation (FAO/WHO), 2001. Evaluation of health and nutritional properties of powder milk and live lactic acid bacteria. FAO and WHO Expert Consultation Report No. 85. Available at: http://www.fao.org/3/a-a0512e.pdf
García-Velasco, J.A., Menabrito, M. and Catalán, I.B., 2017. What fertility specialists should know about the vaginal microbiome: a review. Reproductive BioMedicine Online 35: 103-112.
'What fertility specialists should know about the vaginal microbiome: a review ' () 35 Reproductive BioMedicine Online : 103 -112.
Green, K.A., Zarek, S.M. and Catherino, W.H., 2015. Gynecologic health and disease in relation to the microbiome of the female reproductive tract. Fertility and Sterility 104: 1351-1357. https://doi.org/10.1016/j.fertnstert.2015.10.010
Hemalatha, R., Mastromarino, P., Ramalaxmi, B.A., Balakrishna, N.V. and Sesikeran, B., 2012. Effectiveness of vaginal tablets containing lactobacilli versus pH tablets on vaginal health and inflammatory cytokines: a randomized, double-blind study. European Journal of Clinical Microbiology and Infectious Diseases 31: 3097-3105. https://doi.org/10.1007/s10096-012-1671-1
Hill, C., Guarner, F., Reid, G., Gibson, G., Merenstein, D., Pot, B., Morelli, L., Canani, R., Flint, H.J., Salminen, S., Calder, P.C. and Sanders, M.E., 2014. Expert consensus document: the International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology and Hepatology 11: 506-514. https://doi.org/10.1038/nrgastro.2014.66
Human Microbiome Project Consortium, 2012. Structure, function and diversity of the healthy human microbiome. Nature 486: 207-214. https://doi.org/10.1038/nature11234
Integrative HMP (iHMP) Research Network Consortium, 2014. The Integrative Human Microbiome Project: dynamic analysis of microbiome-host omics profiles during periods of human health and disease. Cell Host and Microbe 16: 276-289. https://doi.org/10.1016/j.chom.2014.08.014
International Scientific Association for Probiotics and Prebiotics (ISAPP), 2013. Probiotics: a consumer guide for making smart choices developed by the International Scientific Association for Probiotics and Prebiotics. ISAPP, Sacramento, CA, USA.
Juárez Tomás, M.S., Bru, E., Martos, G. and Nader-Macías, M.E., 2009. Stability of freeze-dried vaginal Lactobacillus strains in the presence of different lyoprotectors. Canadian Journal of Microbiology 55: 544-552. https://doi.org/10.1139/W08-159
Juárez Tomás, M.S., Otero, M., Ocaña, V. and Nader-Macías, M., 2004. Production of antimicrobial substances by lactic acid bacteria I. In: Spencer, J. and Ragout de Spencer, A. (eds.) Methods in molecular biology. Humana Press Inc., Totowa, NJ, USA, pp. 337-346.
'Production of antimicrobial substances by lactic acid bacteria I ', in Methods in molecular biology , () 337 -346.
Juárez Tomás, M.S., Saralegui Duhart, C.I., De Gregorio, P.R., Vera Pingitore, E. and Nader-Macías, M.E., 2011. Urogenital pathogen inhibition and compatibility between vaginal Lactobacillus strains to be considered as probiotic candidates. European Journal of Obstetrics Gynecology and Reproductive Biology 159: 399-406. https://doi.org/10.1016/j.ejogrb.2011.07.010
Juárez Tomás, M.S., Zonenschain, D., Morelli, L. and Nader-Macías, M.E., 2005. Characterization of potentially probiotic vaginal lactobacilli isolated from Argentinean women. British Journal of Biomedical Science 62: 170-174.
'Characterization of potentially probiotic vaginal lactobacilli isolated from Argentinean women ' () 62 British Journal of Biomedical Science : 170 -174.
Larsson, P.G., Stray-Pedersen, B., Ryttig, K.R. and Larsen, S., 2008. Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Women’s Health 8: 3. https://doi.org/10.1186/1472-6874-8-3
Leccese Terraf, M.C., Juarez Tomás, M.S., Rault, L., Le Loir, Y., Even, S. and Nader-Macías, M.E.F., 2017. In vitro effect of vaginal lactobacilli on the growth and adhesion abilities of uropathogenic Escherichia coli. Archives of Microbiology. 199: 767-774. https://doi.org/10.1007/s00203-016-1336-z
Leccese Terraf, M.C., Mendoza, L.M., Juares Tomás, M.S., Silva, C. and Nader-Macías, M.E.F., 2014. Phenotypic surface properties (aggregation, adhesion and biofilm formation) and presence of related genes in beneficial vaginal lactobacilli. Journal of Applied Microbiology 117: 1761-1772. https://doi.org/10.1111/jam.12642
Leccese Terraf, M.C.L., Juárez Tomás, M.S., Nader-Macías, M.E.F. and Silva, C., 2012. Screening of biofilm formation by beneficial vaginal lactobacilli and influence of culture media components. Journal of Applied Microbiology 113: 1517-1529. https://doi.org/10.1111/j.1365-2672.2012.05429.x
Lopes dos Santos Santiago, G., Verstraelen, H., Poelvoorde, N., De Corte, S., Claeys, G., Trog, M., De Backer, E., Saerens, B., Vervaet, C., De Boeck, F., Van Bortel, L., Remon, J.P., Temmerman, M., Vaneechoutte, M. and Verhelst, R., 2009. A pilot study evaluating the safety of vaginal administration of a multi-particulate pellet formulation. European Journal of Pharmaceutics and Biopharmaceutics 73: 399-403. https://doi.org/10.1016/j.ejpb.2009.08.009
Marchesi, A., Silva, J.A., Aristimuño Ficoseco, C. and Nader-Macías, M.E.F., 2016. Safety characteristics of beneficial vaginal lactic acid bacteria (LAB) to be included in a probiotic product. Medicina 76, Suppl. I: 277.
'Safety characteristics of beneficial vaginal lactic acid bacteria (LAB) to be included in a probiotic product ' () 76 Medicina : 27 -.
Moreno, I., Codoñer, F.M., Vilella, F., Valbuena, D., Martinez-Blanch, J.F., Jimenez-Almazán, J., Alonso, R., Alamá, P., Remohí, J., Pellicer, A., Ramon, D. and Simon, C., 2016. Evidence that the endometrial microbiota has an effect on implantation success or failure. American Journal of Obstetrics and Gynecology 215: 684-703.
'Evidence that the endometrial microbiota has an effect on implantation success or failure ' () 215 American Journal of Obstetrics and Gynecology : 684 -703.
Nugent, R.P., Krohn, M.A. and Hillier, S.L., 1991. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology 29: 297-301. https://doi.org/10.1136/sti.2003.006106
Ocaña, V.S., Bru, E., De Ruiz Holgado, A.A. and Nader-Macías, M.E., 1999a. Surface characteristics of lactobacilli isolated from human vagina. Journal of General Applied and Microbiology 45: 203-212.
'Surface characteristics of lactobacilli isolated from human vagina ' () 45 Journal of General Applied and Microbiology : 203 -212.
Ocaña, V.S., Pesce de Ruiz Holgado, A.A. and Nader-Macías, M.E., 1999b. Selection of vaginal H2O2-generating Lactobacillus species for probiotic use. Current Microbiology 38: 279-284.
'Selection of vaginal H2O2-generating Lactobacillus species for probiotic use ' () 38 Current Microbiology : 279 -284.
Petrova, M.I., Lievens, E., Malik, S., Imholz, N. and Lebeer, S., 2015. Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health. Frontiers in Physiology 6: 81.
'Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health ' () 6 Frontiers in Physiology : 81 -.
Prince, A.L., Chu, D.M., Seferovic, M.D., Antony, K.M., Ma, J. and Aagaard, K.M., 2015. The perinatal microbiome and pregnancy: moving beyond the vaginal microbiome. Cold Spring Harbor Perspectives in Medicine 5: a023051.
'The perinatal microbiome and pregnancy: moving beyond the vaginal microbiome ' () 5 Cold Spring Harbor Perspectives in Medicine : a023051 -.
Reid, G., 2014. Modulating the vaginal microbiome: the need for a bridge between science and practice. Seminars in Reproductive Medicine 32: 28-34. https://doi.org/10.1055/s-0033-1361820
Reid, G., 2017a. Therapeutic opportunities in the vaginal microbiome. In: Britton, R.A. and Cani, P.D. (eds.) Bugs as drugs: therapeutic microbes for the prevention and treatment of disease. ASM Press, Washington, DC, USA. https://doi.org/10.1128/microbiolspec.BAD-0001-2016
Reid, G., 2017b. The development of probiotics for women’s health. Canadian Journal of Microbiology 63: 269-277.
'The development of probiotics for women’s health ' () 63 Canadian Journal of Microbiology : 269 -277.
Reid, G., Jass, J., Sebulsky, M.T. and McCormick, J.K., 2003. Potential uses of probiotics in clinical practice. Clinical Microbiology Reviews 16: 658-672. https://doi.org/10.1128/CMR.16.4.658-672.2003
Silva de Ruiz, C., Rey, M.R., Pesce de Ruiz Holgado, A. and Nader-Macías, M.E., 2001. Experimental administration of estradiol on the colonization of Lactobacillus fermentum and Escherichia coli in the urogenital tract of mice. Biological and Pharmaceutical Bulletin 24: 127-134. https://doi.org/10.1248/bpb.24.127
Strus, M., Chmielarczyk, A., Kochan, P., Adamski, P., Chełmicki, Z., Chełmicki, A., Pałucha, A. and Heczko, P., 2012. Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. European Journal of Obstetrics and Gynecology and Reproductive Biology 163: 210-215. https://doi.org/10.1016/j.ejogrb.2012.05.001
Tomusiak, A., Strus, M., Heczko, P.B., Adamski, P., Stefański, G., Mikołajczyk-Cichońska, A. and Suda-Szczurek, M., 2015. Efficacy and safety of a vaginal medicinal product containing three strains of probiotic bacteria: a multicenter, randomized, double-blind, and placebo-controlled trial. Drug Design, Development and Therapy 9: 5345-5354. https://doi.org/10.2147/DDDT.S89214
Vera Pingitore, E., Hébert, M.E., Nader-Macías, M.E. and Sesma, F., 2009. Characterization of salivaricin CRL 1328, a two-peptide bacteriocin produced by Lactobacillus salivarius CRL 1328 isolated from the human vagina. Research in Microbiology 160: 401-408. https://doi.org/10.1016/j.resmic.2009.06.009
Wagenlehner, F., Wullt, B., Ballarini, S., Zingg, D. and Naber, K.G., 2018. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Review of Pharmacoeconomics and Outcomes Research 18: 107-117. https://doi.org/10.1080/14737167.2017.1359543
Witkin, S., 2015. The vaginal microbiome, vaginal anti-microbial defense mechanisms and the clinical challenge of reducing infection-related preterm birth. BJOG 122: 213-218. https://doi.org/10.1111/1471-0528.13115
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1227 | 345 | 38 |
| Full Text Views | 36 | 17 | 2 |
| PDF Views & Downloads | 64 | 42 | 0 |
Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1227 | 345 | 38 |
| Full Text Views | 36 | 17 | 2 |
| PDF Views & Downloads | 64 | 42 | 0 |