Innate immunity and vaginal microbiota in pregnant women with bacterial vaginosis in the first trimester

Objective. To study the indicators of vaginal mucosal innate immunity in the presence of bacterial vaginosis in the first trimester of pregnancy. Subjects and methods. This prospective study enrolled 50pregnant women with bacterial vaginosis. There was a study group of 30 people receiving Tergynan therapy for 10 days and a control one of 20 people having Hexicon therapy for 10 days; their mean age was 31±3.1 and 28±2.4 years, respectively. The investigators conducted a study of vaginal microbiocenosis using PCR (Florocenosis + NCMT tests) and a culture assay for L. crispatus; as well as an immunological analysis of the expression of innate immunity genes, such as Toll-like receptor-9 (TLR-9), tumor necrosis factor-a (TNF-a), and peptide human P-defensin-1 (HBD1), by real-time reverse transcription PCR, and statistical processing (Microsoft Excel 2016 and Statistica 6.1). Results. In the study group, the total bacterial contamination exceeded 7 lg GE/ml; the Lactobacillus titer was 4 lg CFU/ml, as shown by a culture assay; there was a preponderance of L. rhamnosus (73.3%), L. jensenii (40%), and L. crispatus (10%). The microbiological signs of bacterial vaginosis persisted in 30 and 10% of patients after 10 and 30 days of treatment, respectively. Thirty days after therapy termination, there was a 10-fold increase in the titer of Lactobacillus; L. crispatus was found to grow in 60%. The culture assay revealed no Lactobacillus growth in 35% in the control group. L. rhamnosus (75%), L. jensenii (25%), L. crispatus (15%), and L. fermentum (10%) were identified according to the species composition. After 10 and 30 days of treatment, the microbiological signs of the disease persisted in 25 and 45%, respectively. Thirty days after therapy, the Lactobacillus titer reached 6.5 lg CFU/ml; L. crispatus was detected in 55%. Both groups exhibited no significant changes in TNF-a and TLR9 gene expressions. In the study group, the level of HBD1 steadily decreased by 1.7 times from the baseline values; in the control group, the decrease in defensin was short-term and increased at day 30. Conclusion. During the course of treatment, the recurrence rate decreased, normalization of the vaginal microbiocenosis with the growth of protective types of lactobacilli and the balance in the expression of innate immunity factors were noted.

TLR9, bacterial vaginosis, pregnancy, innate immunity, microbiome, tumor necrosis factor, Toll-like receptor-9, defensin, tergynan, hexicon