Improvement of vaginal probiotics Lactobacillus crispatus on intrauterine adhesion in mice model and in clinical practice

Abstract

AbstractBackgroundIntrauterine adhesion (IUA) is a frequent acquired endometrial condition, for which there is no effective preventive or treatment. Previous studies have found that vaginal microbiota dysregulation is closely related to endometrial fibrosis and IUA. Therefore, we wondered whether restoration of vaginal microbiota by vaginal administration ofL. crispatuscould prevent endometrial fibrosis and ameliorate IUA.ResultsFirst, we created a mechanically injured mouse model of IUA and restored the mice’s vaginal microbiota by the addition ofL. crispatusconvolvulus. The observations suggested that intrauterine injections ofL. crispatussignificantly decreased the degree of uterine fibrosis, the levels of IL-1β and TNF-α in blood, and downregulated the TGF-β1/SMADs signaling pathway in IUA mice. A therapy withL. crispatusconsiderably raised the abundance of the helpful bacteriaLactobacillusandOscillospiraand restored the balance of the vaginal microbiota in IUA mice, according to high-throughput sequencing. Then we conducted a randomized controlled trial to compare the therapeutic effect ofL. crispatuswith estrogen after transcervical resection of adhesion (TCRA). And the results showed that vaginal probiotics had a better potential to prevent intrauterine adhesion than estrogen.ConclusionsThis study confirmed thatL. crispatuscould restore vaginal microbiota after intrauterine surgery, inhibit endometrial fibrosis, and finally play a preventive and therapeutic role in IUA. At the same time, it is a new exploration for the treatment of gynecological diseases with vaginal probiotics.Clinical trial registration:http://www.chictr.org.cn/, identifier (ChiCTR1900022522), registration time: 15/04/2019.