Recurrent vulvovaginal candidiasis: a dynamic interkingdom biofilm disease of Candida and Lactobacillus. Homo sapiens

This study aimed to assess a panel of clinical samples from healthy women and those with RVVC to investigate the influence of Candida, the vaginal microbiome, and how their interaction influenced disease pathology. 16S rRNA sequencing characterised disease by a reduction in specific health-associated Lactobacillus species such as L. crispatus, coupled with an increase in L. iners. In vitro analysis showed Candida albicans clinical isolates are capable of heterogeneous biofilm formation and show the presence of hyphae and C. albicans aggregates in vaginal lavage. Additionally, the ability of Lactobacillus to inhibit C. albicans biofilm formation and biofilm-related gene expression was demonstrated. Using RNA sequencing technology, we were able to exploit a possible mechanism by which L. crispatus may aim to re-establish a healthy vaginal environment through amino-acid acquisition from C. albicans. This study suggests RVVC is not entirely due to an arbitrary switch in C. albicans from commensal to pathogen and understanding interactions between the yeast and vaginal Lactobacillus species may be more crucial to elucidating the cause of RVVC and developing appropriate therapies.

本研究旨在收集健康女性与复发性外阴阴道假丝酵母菌病（Recurrent Vulvovaginal Candidiasis, RVVC）患者的一系列临床样本，以评估假丝酵母菌（Candida）、阴道微生物组的影响，并探究二者的相互作用如何影响疾病病理进程。通过16S rRNA测序分析，本研究发现该疾病的特征为特定健康相关乳酸杆菌（Lactobacillus）物种丰度降低，例如卷曲乳酸杆菌（L. crispatus），同时惰性乳酸杆菌（L. iners）丰度升高。体外实验结果显示，白色假丝酵母菌（Candida albicans）临床分离株可形成异质性生物膜，且在阴道灌洗液中可检测到菌丝与白色假丝酵母菌聚集体。此外，本研究证实乳酸杆菌可抑制白色假丝酵母菌生物膜形成及生物膜相关基因的表达。借助RNA测序技术，本研究揭示了卷曲乳酸杆菌可能通过从白色假丝酵母菌中获取氨基酸以重建健康阴道微环境的潜在机制。本研究表明，RVVC并非完全由白色假丝酵母菌从共生状态向致病状态的随机转化所导致；深入理解该酵母菌与阴道乳酸杆菌之间的相互作用，对于阐明RVVC的发病机制及开发合适的治疗方案至关重要。