VAGINAL fluid transplants could hold the key to curing nasty infections, doctors say.
Researchers at Johns Hopkins University in Maryland, US, say they have taken the first step towards trials of vaginal microbiota transplantation (VMT).
The team say they were inspired by the success of faecal microbiota transplantation (FMT) used to treat debilitating gut condition, clostridium difficile.
Known as a poo transplant, it involves transferring the stool from a healthy donor into the gastrointestinal tract of the sick patient to restore the balance of bacteria and help them fight the infection.
The experts hope that transplanting vaginal fluids from healthy donors will provide the first restorative, curative treatment for bacterial vaginosis.
Published in Frontiers in Cellular and Infection Microbiology, the team’s donor screening concept aims to ensure that only beneficial microbes are transferred by VMT – and not potential pathogens.
Dr Ethel Weld, study co-author, said: "We have very few treatment options available for BV, none of them fully curative or restorative.
“There is significant epidemiological evidence that vaginal microbiota transfer already occurs, for example between women who have sex with women.
“But before clinical trials of VMT are conducted, we must first determine how to screen donors to find those with minimal risk of transmissible pathogens, and optimal vaginal microbiota for transplant.”
What is bacterial vaginosis (BV)?
Bacterial vaginosis (BV) is the most common vaginal health condition.
Gynaecologist, Anne Henderson explains: “BV is caused by Gardnerella Vaginalis which is a specific bacteria.
"It can be sexually transmitted but it can also be related to an upset in the general imbalance in the vagina.
"The condition causes a very runny, watery discharge and fishy odour, but doesn't cause as much discomfort as thrush."
While it is common, it can be dangerous if left un-or-misdiagnosed, because it can increase your risk of STIs, pre-term birth and low birth weight, as well as pelvic inflammatory disease.
Dr Weld and colleagues designed a universal screening approach for VMT donors, which they piloted in a small sample of 20 healthy women aged 23-35.
The screening consists of a medical questionnaire with blood, urine, and vaginal swab and fluid testing.
As well as checking for exposure to STIs and other infections, analysis of the samples allowed the team to correlate vaginal bacterial community structure with function.
The results support a testing hierarchy, whereby unfit samples can be screened out with cheap but reliable tests.
They found that the "ideal" donor bacterial profile depends on the recipient but the pilot did provide some insights.
We have very few treatment options available for BV, none of them fully curative or restorativeDr Ethel Weld
For example, vaginal fluid samples dominated by the Lactobacillus species L. crispatus tended to have higher protective lactic acid content, lower pH, and greater HIV barrier function, in agreement with previous studies.
The researchers say that what they do know about the ideal VMT donor is that she is rare.
Co-author Dr Laura Ensign said: “Based on our exclusion criteria, 35 per cent of these participants might be eligible VMT donors.
"But the actual success rate for participation as a VMT donor in a clinical trial will likely be much lower still.”
The participants were selected from the study team’s previous clinical studies, increasing the likelihood that they would fulfil the donor criteria.
Most were White or East Asian women, who in the US are least likely to have BV.
Dr Ensign encourages efforts to recruit a more diverse donor pool, to identify whether there is any impact of race or ethnicity on VMT success.
And besides invasive screening, the privations of vaginal fluid sample collection are likely to deter many would-be donors.
She added: “Out of an abundance of caution, we propose that donors abstain from vaginal intercourse for the duration of longitudinal sample collection."
This could amount to 30 days or more without sex and as such, the success of VMT might depend on a small number of willing ‘super donors’.
She added: “Once a safe donor has been identified using this protocol, she could donate on multiple appropriately screened occasions.
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"The idea of a ‘super-donor’ with no identified past or current infections and with favourable Lactobacillus-dominated microbiota is one that should be explored.”
Ultimately, understanding the role of minority bacterial species and their products could enable VMT to progress beyond the need for donors.
Dr Ensign added: “We anticipate that the trajectory of VMT will likely follow that of faecal transplantation, with efforts to cultivate uniform, standardised transplants that have similar therapeutic efficacy to donor material."
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