Mother’s eyes, her mitochondria, and her microbes: Women & their Microbes

A healthy woman, a healthy baby, a healthy generation

Women have an enormous impact on global health. Because of their role in reproduction and child-bearing, being able to positively affect the health of a mother ensures greater health potential for future generations. Within the past 5 years alone, multiple facets of reproduction have been linked with the microbiome from gametogenesis to pregnancy outcomes.

The associations do not stop there: obstetrics and breastfeeding provide critical windows for microbial priming and transfer that have an undeniably significant impact on infant health and development. This represents a paradigm shift not only for modern medicine but also for science, stressing the need for awareness and clear communication in the future.

The microbiome is upon us

The microbiome represents the total community of bacteria and their interactions in a particular human niche. Since 2008, over 500 clinical studies have been published on the human microbiome. In women’s health, lactobacilli species appear to have ecological dominance in many niches, but this is also dependent on the age, health status, menstrual and reproductive status of the woman.

Of course while there are bacteria in multiple body niches, the microbiome is not a panacea; the emerging evidence must be examined with a critical eye.

Tantalizing puzzle pieces

Traditionally medicine has held a rather negative view of bacteria, and with good reason! However, pathogens are vastly outnumbered by the commensal (naturally present) bacteria. This represents a challenge because knowledge of the role of the commensal microbiome is absent in medical training, but also an opportunity because of the growing associations of health and the microbiome.

Recent research discoveries warrant further investigation. Microbial DNA and live organisms have been found in forbidden places: the uterus, placenta, amniotic fluid, and the breast to name a few. If certain bacteria are present on an IVF needle, the chance of fertilization increases dramatically.

Sperm cells have a receptor for LPS (a molecule on the surface of certain bacteria), and sperm motility decreases if a certain binding threshold of LPS is achieved. We also know also that the vaginal microbiome composition naturally changes across the duration of pregnancy, suggesting that in addition to the preparatory physiological changes, microbial changes also should occur before birth.

Similar associations are emerging around urogenital infections, for instance with bacterial vaginosis (BV). Vaginal microbiome research suggests that Koch’s postulates do not apply for BV. The vaginal microbiomes of asymptomatic women and women diagnosed with BV have distinct community clusters.

Asymptomatic women are usually dominated by one species of lactobacilli, while women with BV have a much higher diversity of vaginal microbial species in a thick biofilm and these biofilms can be disrupted by alternative treatments such as probiotics.

New and exciting insights are also emerging in urology. Dogma-challenging research has proven that urine is not sterile – live bacteria exist and function. In the bladder reservoir, different communities of bacteria have also been identified in various patient types from UTIs to UUI.

Neuromuscular receptors on the muscular bladder wall can be influenced by bacteria – an association to explore further for additional insights into urinary incontinence and pelvic floor function. While the research still requires more corroboration and evidence, there is clearly a promising future for the microbiome within medicine.

Challenge outlined

The microbiome challenges the traditional view of health and disease with new concepts such as functional niche-specific microbial communities, diversity, dysbiosis, and key species. While these concepts are becoming engrained into the investigative and language of many interdisciplinary research collaborations, they still need to be explained to outsiders.

Furthermore, what sort of challenge does the microbiome represent within diagnosis and treatment? It is hard to say at the moment, but given high treatment failure rates and non-responders, it might change what we target. A more complete characterization of the symbiosis between women and bacteria is imperative as we strive to understand its implications in health and disease.

While the scientific body of knowledge is increasing rapidly by the hard work of scientists, physicians and patients are not always aware of the opportunities and progress. Emphasis from both sides should be placed on communication to increase awareness and look for collaborative opportunities. The tipping point will come when healthcare professionals and patients are invited to the table and included in the discussion.

Resistance inspires

I studied how vaginal bacteria adhered to each other and the epithelium within the vaginal environment in my PhD. However when I wanted to communicate my work to get feedback and new ideas within a greater context, I was hard-pressed to find suitable scientific meetings. To my surprise there was no dedicated conference and I was often met with strange looks and dismissed as a young over-enthusiastic female scientist. My task became clear: create an international scientific conference where scientists and clinicians can sit together and discuss how bacteria impact women.

My goal became a reality in 2015 in Amsterdam and Women & their Microbes was a huge success with over 90 participants from over nine countries. The organizing committee is building up the momentum together with the advisory board to host the next conference on Monday, June 13th, 2016.

The theme is reproduction and the one-day program includes morning lecture sessions that will take us through the intimate relationship and influence that bacteria have on reproduction. In the afternoon, attendees can choose from four different hands-on workshops aimed at making current science practical and accessible for patients, healthcare professionals students, and researchers.

If you are interested in finding out more information about the conference or would like to register, you can visit the website at womenandtheirmicrobes.com.

The initiative

Women & their Microbes is designed to be a unique knowledge forum for clinicians, academics, and industry scientists to discuss both cutting-edge and practical research about the role of bacteria in women’s health. It also aims to create initiatives that enhance healthcare professional and patient awareness and knowledge about the importance of bacteria for women with the following points as inspiration:

  • Every mother is entitled to a healthy pregnancy.
  • Every baby has the right to a healthy microbial inheritance.
  • Every child deserves healthy microbial and physical development.
  • Every person is worthy of healthy aging

A more important and necessary outcome of these pieces of knowledge are developments that have and will enable the scientific and medical communities to understand and harness the potential of bacteria to affect women’s health.

If you have any further questions about any of the research discussed earlier or about the conference, please contact Jessica Younes (PhD) at womenmicrobes@gmail.com for more information. The most insightful and powerful findings may lie just ahead and I truly hope that healthcare professionals and patients will play a big role in this journey.

 

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