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Urogenital probiotics: potential role of Lactobacillus in the prevention of urogenital infections in women
Umeå University, Faculty of Medicine, Clinical Microbiology.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The human vaginal ecosystem is dominated by Lactobacillus species. An altered vaginal flora can result in symptomatic conditions such as bacterial vaginosis and vulvo-vaginal candidiasis, and urogenital colonisation by uropathogenic bacteria can cause urinary tract infection. The protective role of lactobacilli is gradually being accepted and clinical studies have been carried out in order to evaluate the use of promising probiotic bacteria, which are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host”.

This thesis includes an investigation into the ecological role of lactobacilli in the genital tract in healthy women, with respect to the relationship to other species and vaginal pH. Furthermore, in order to find different probiotic strains with promising probiotic qualities, Lactobacillus strains were screened in two diverse screening processes. The selected strains were further evaluated in clinical trials.

The prevalence of group B streptococci (GBS) and yeast was significantly dependent on the number of vaginal lactobacilli among healthy women. GBS were less frequently found in women with high numbers of vaginal lactobacilli than in women with low numbers and the prevalence of yeast was significantly higher in women with 3-6.99 log10 lactobacilli sample-1 than in women with less than 3 or ≥7 log10 lactobacilli sample-1. Furthermore, the first screening made on 511 strains isolated from the female genital tract resulted in the final selection of a Lactobacillus plantarum, designated LB931. The screening showed that LB931 had a strong technical growth, survived through freeze-thawing, produced substances bactericidal to uropathogenic bacteria and was a rapid and strong producer of hydrogen peroxide. Further characterisation showed that LB931 possessed the properties required for probiotics with the capability to prevent urogenital infections. LB931 could be supplied to the genital tract through the usage of panty liners impregnated with the strain. In the second screening, Lactobacillus fermentum, designated Ess-1, was the only one out of 126 Lactobacillus strains with strong capacity to inhibit Candida albicans and Candida glabrata. Additional characterisation showed that L. fermentum Ess-1 had the properties that are needed to prevent over-growth of Candida in the vulvo-vaginal tract. The result of the case study showed that a high and frequent dosage of Ess-1 is needed and that improved vulvo-vaginal candidiasis specific diagnostic criteria are required.

In conclusion, L. plantarum LB931 and L. fermentum Ess-1 are promising probiotic strains to be used in the prevention of recurrent urogenital infections in women and to enhance the normal flora in healthy women.

Place, publisher, year, edition, pages
Umeå: Klinisk mikrobiologi , 2007. , 52 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1128
Keyword [en]
Lactobacillus, normal flora, probiotics, urogenital infections, Candida
National Category
Microbiology in the medical area
Identifiers
URN: urn:nbn:se:umu:diva-1400ISBN: 91-7264-419-9 OAI: oai:DiVA.org:umu-1400DiVA: diva2:140904
Public defence
2007-11-09, E04, E6, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2009-09-24Bibliographically approved
List of papers
1. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH.
Open this publication in new window or tab >>Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH.
2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 6, 726-735 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The relationship between lactobacilli and other microbes and the association with vaginal pH in the female genital tract were examined. The study also included evaluation of the possibility of supplying probiotics to the genital tract by using panty liners impregnated with the probiotic strain Lactobacillus plantarum LB931. METHODS: This was a randomized, placebo-controlled, double-blind, multicenter study involving 191 healthy fertile women. Specified microbes were counted and vaginal pH was measured once a month for five consecutive months. RESULTS: Major individual variations in the genital microflora composition and the vaginal pH were found among the women. The number of lactobacilli was significantly related to vaginal pH (p<0.001) and approximately 70% of the women were permanent carriers of individual lactobacilli strains. Women with high numbers of lactobacilli were less prevalent with Group B streptococci than women with low numbers (p=0.036), and these women had a lower mean vaginal pH. The number of lactobacilli also correlated with the prevalence of yeast. LB931 could be found in 86% of the labial samples and 54% of the vaginal samples. CONCLUSIONS: High numbers of lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci. LB931 could be transferred from the panty liners to both the vagina and the labial fold.

Identifiers
urn:nbn:se:umu:diva-21261 (URN)10.1080/00016340600578357 (DOI)16752267 (PubMedID)
Available from: 2009-04-09 Created: 2009-04-09 Last updated: 2017-12-13
2. Selection and characterization of a Lactobacillus plantarum strain promising as a urogenital probiotic
Open this publication in new window or tab >>Selection and characterization of a Lactobacillus plantarum strain promising as a urogenital probiotic
2005 (English)In: Microbiological Ecology in Health and Disease, ISSN 0891-060X, Vol. 17, no 2, 75-82 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2668 (URN)10.1080/08910600510037992 (DOI)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2009-09-24Bibliographically approved
3. Lactobacillus fermentum Ess-1 with unique growth inhibition of vulvo-vaginal candidiasis pathogens.
Open this publication in new window or tab >>Lactobacillus fermentum Ess-1 with unique growth inhibition of vulvo-vaginal candidiasis pathogens.
2007 (English)In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 56, no Pt 11, 1500-1504 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to characterize human isolates of Lactobacillus species for their capacity to interfere with the growth of different strains of Candida species in vitro in the search for a potential probiotic. Growth inhibition of Candida species was screened using an agar-overlay method. Inhibiting strains were selected to assay the effect of a cell-free Lactobacillus culture filtrate (LCF) on the growth of isolates of Candida albicans and Candida glabrata. A total of 126 human Lactobacillus isolates was investigated. Eighteen isolates significantly inhibited the growth of C. albicans on agar. The LCF of one of these strains showed strong inhibition of both C. albicans and C. glabrata. This strain was genetically identified as Lactobacillus fermentum and designated L. fermentum Ess-1. Further tests to evaluate the probiotic potential of this strain indicated that L. fermentum Ess-1 strain is a promising probiotic for use in clinical trials to treat and prevent vulvo-vaginal candidiasis.

Identifiers
urn:nbn:se:umu:diva-21148 (URN)10.1099/jmm.0.47226-0 (DOI)17965352 (PubMedID)
Available from: 2009-04-03 Created: 2009-04-03 Last updated: 2017-12-13
4. Lactobacillus fermentum Ess-1 administered to women with vulvo-vaginal candidiasis: report of six cases
Open this publication in new window or tab >>Lactobacillus fermentum Ess-1 administered to women with vulvo-vaginal candidiasis: report of six cases
(English)Manuscript (Other (popular science, discussion, etc.))
Identifiers
urn:nbn:se:umu:diva-2670 (URN)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2010-01-14Bibliographically approved

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