Harnessing the power within: engineering the microbiome for enhanced gynecologic health

Caitriona Brennan; Kristina Chan; Tanya Kumar; Erica Maissy; Linda Brubaker; Marisol I Dothard; Jack A Gilbert; Katharine E Gilbert; Amanda L Lewis; Varykina G Thackray; Amir Zarrinpar; Rob Knight

doi:10.1530/RAF-23-0060

Reproduction and Fertility (Apr 2024)

Harnessing the power within: engineering the microbiome for enhanced gynecologic health

Caitriona Brennan,
Kristina Chan,
Tanya Kumar,
Erica Maissy,
Linda Brubaker,
Marisol I Dothard,
Jack A Gilbert,
Katharine E Gilbert,
Amanda L Lewis,
Varykina G Thackray,
Amir Zarrinpar,
Rob Knight

Affiliations

Caitriona Brennan: Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Division of Biological Sciences, University of California San Diego, La Jolla, California, USA
Kristina Chan: Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Tanya Kumar: Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA
Erica Maissy: Division of Gastroenterology, University of California San Diego, La Jolla, California, USA; Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA
Linda Brubaker: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Marisol I Dothard: Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA
Jack A Gilbert: Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Katharine E Gilbert: Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Amanda L Lewis: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Varykina G Thackray: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Amir Zarrinpar: Department of Bioengineering, University of California, San Diego, La Jolla, California, USA; Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA; Division of Gastroenterology, University of California San Diego, La Jolla, California, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA; Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA; Institute of Diabetes and Metabolic Health, University of California San Diego, La Jolla, California, USA
Rob Knight: Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Department of Bioengineering, University of California, San Diego, La Jolla, California, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA; Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, USA; Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA

DOI: https://doi.org/10.1530/RAF-23-0060
Journal volume & issue: Vol. 5, no. 2
pp. 1 – 17

Abstract

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Abstract Although numerous studies have demonstrated the impact of microbiome manipulation on human health, research on the microbiome’s influence on female health remains relatively limited despite substantial disease burden. In light of this, we present a selected review of clinical trials and preclinical studies targeting both the vaginal and gut microbiomes for the prevention or treatment of various gynecologic conditions. Specifically, we explore studies that leverage microbiota transplants, probiotics, prebiotics, diet modifications, and engineered microbial strains. A healthy vaginal microbiome for females of reproductive age consists of lactic acid-producing bacteria predominantly of the Lactobacillus genus, which serves as a protective barrier against pathogens and maintains a balanced ecosystem. The gut microbiota’s production of short-chain fatty acids, metabolism of primary bile acids, and modulation of sex steroid levels have significant implications for the interplay between host and microbes throughout the body, ultimately impacting reproductive health. By harnessing interventions that modulate both the vaginal and gut microbiomes, it becomes possible to not only maintain homeostasis but also mitigate pathological conditions. While the field is still working toward making broad clinical recommendations, the current studies demonstrate that manipulating the microbiome holds great potential for addressing diverse gynecologic conditions. Lay summary Manipulating the microbiome has recently entered popular culture, with various diets thought to aid the microbes that live within us. These microbes live in different locations of our body and accordingly help us digest food, modulate our immune system, and influence reproductive health. The role of the microbes living in and influencing the female reproductive tract remains understudied despite known roles in common conditions such as vulvovaginal candidiasis (affecting 75% of females in their lifetime), bacterial vaginosis (25% of females in their lifetime), cervical HPV infection (80% of females in their lifetime), endometriosis (6–10% of females of reproductive age), and polycystic ovary syndrome (10–12% of females of reproductive age). Here, we review four different approaches used to manipulate the female reproductive tract and gastrointestinal system microbiomes: microbiota transplants, probiotics, prebiotics, and dietary interventions, and the use of engineered microbial strains. In doing so, we aim to stimulate discussion on new ways to understand and treat female reproductive health conditions.

Published in Reproduction and Fertility

ISSN: 2633-8386 (Online)
Publisher: Bioscientifica
Country of publisher: United Kingdom
LCC subjects: Science: Biology (General): Reproduction; Medicine: Gynecology and obstetrics
Website: https://raf.bioscientifica.com/

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Abstract

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