Divine Aleru, Microbiome Signatures Research Coordinator

This review links gut microbiota disruption to the development and symptoms of COS, including insulin resistance and hyperandrogenism. It highlights microbiota-targeted therapies—like probiotics, prebiotics, and traditional medicine—as promising options to improve COS outcomes and repositions the gut microbiome as a central factor in understanding and treating the disorder.

Metronidazole is a synthetic nitroimidazole antimicrobial agent classified as a pharmaceutical antibiotic, widely used to treat anaerobic bacterial and protozoal infections. Its therapeutic application spans a range of systemic and localized conditions, including bacterial vaginosis, gastrointestinal infections, and surgical prophylaxis.[1][2][3] Due to its ability to selectively target anaerobic organisms and protozoa, metronidazole has become a […]

This study found a significant association between metronidazole use and neurologic toxicity, including encephalopathy and peripheral neuropathy, especially in older adults. Even low doses of metronidazole were linked to an increased risk of adverse events, emphasizing the need for careful monitoring and alternative therapies for high-risk patients.

This study uncovers complex mechanisms of metronidazole resistance in C. difficile, highlighting key genetic mutations and iron-dependent metabolic shifts that reduce drug efficacy. These findings inform future therapeutic strategies to address C. difficile infections.

This meta-analysis confirms that regional resistance patterns heavily influence H. pylori eradication success. In areas with low metronidazole and high clarithromycin resistance, AM significantly outperforms AC. These findings support microbiome-informed, resistance-guided therapy selection.

This large study confirms that prior metronidazole exposure significantly reduces H. pylori eradication rates with QT. Extending treatment to 14 days restores effectiveness. The findings highlight the microbiome-relevant impact of antibiotic history and support individualized treatment planning.

This review established metronidazole as the standard treatment for giardiasis, highlighting its microbial mechanism, resistance patterns, and microbiome-disruptive potential. The authors call for individualized, microbiome-aware therapy that balances efficacy with host-microbial homeostasis.

This clinical trial found that metronidazole significantly reduced inflammation—especially SR and L-6 levels—in OVID-19 pneumonia. The results support its immunomodulatory effects beyond infection control and encourage its careful use as a microbiome-sensitive anti-inflammatory agent.

This study demonstrated that metronidazole reduces inflammation and pro-inflammatory cytokines in a murine model, suggesting its anti-inflammatory properties are independent of antimicrobial action. These findings highlight its potential in microbiome-modulating therapies for non-infectious inflammation.

This study shows metronidazole significantly reduces inflammation and blood loss in SAID enteropathy. It likely acts by targeting anaerobic microbes that drive neutrophil-mediated damage, offering a microbiome-relevant intervention for small intestinal injury.

This review dissected the metabolism, cytotoxic intermediates, and resistance mechanisms of metronidazole. It confirmed its microbial dependence for activation, its broad microbiome-disruptive potential, and the emerging resistance pathways beyond nim genes—emphasizing a shift toward targeted, microbiome-sparing alternatives in clinical practice.

This review confirms metronidazole’s high efficacy in treating I protozoal infections while raising microbiome and resistance concerns. Its targeted use remains standard in acute infections, but clinicians should monitor duration and microbial consequences to reduce long-term harm and support stewardship.

This review explores metronidazole’s clinical efficacy, safety concerns, and microbiome impact. It confirms its value in treating anaerobic infections but highlights potential neurotoxic and genotoxic risks. The review calls for more human studies and microbiome-focused evaluations to guide safer, more targeted antimicrobial use.

This randomized trial showed oral metronidazole matched V administration in preventing infections after open appendectomy for nonperforated appendicitis, suggesting a cost-effective and microbiome-conscious alternative.

Lactoferrin (F) is a naturally occurring iron-binding glycoprotein classified as a postbiotic with immunomodulatory, antimicrobial, and prebiotic-like properties.

This review outlines lactoferrin’s selective antimicrobial and prebiotic effects, showing how it inhibits pathogens while promoting specific probiotic strains through iron sequestration, metabolic modulation, and glycan delivery.

Lactoferrin supports vaginal microbiome balance by inhibiting pathogens and enhancing Lactobacillus colonization, with immunomodulatory effects.

Lactoferrin effectively inhibits Gram-positive and Gram-negative pathogens via iron sequestration and membrane disruption, with microbiome-preserving potential.

This 22-year review maps lactoferrin’s antibacterial research, highlighting its pathogen-specific inhibition, microbiome support, and clinical promise.

Lactoferrin blocks viral entry, activates immune responses, and reduces the severity of common infections, making it a promising preventive tool.

This review found oral lactoferrin to be safe and potentially beneficial in viral infections, but clinical outcomes remain inconsistent.

Lactoferrin and its peptides block pathogen virulence, reduce toxin production, and disrupt biofilms, offering a microbiome-safe antimicrobial strategy.

Lactoferrin prevents viral entry by binding to host cell receptors and viral particles, reducing apoptosis and inflammation while preserving microbiome stability.

What was reviewed?This review examined the antifungal properties of lactoferrin (Lf) and its derived peptides, especially lactoferricin, lactoferrampin, and Lf(1–11), highlighting their mechanisms of action and potential for synergistic use with antifungal drugs. The paper consolidated findings from multiple in vitro and some in vivo studies to explain how these molecules exert direct antifungal activity, […]

This study shows lactoferrin is broadly antifungal against yeasts and synergizes potently with amphotericin B, even in resistant strains. It disrupts fungal virulence and reduces drug burden, highlighting its therapeutic potential.

This review explores lactoferrin’s anti-nociceptive potential through key neuroimmune pathways and highlights its utility as an adjunct to opioids. Its mechanistic effects on RAF6–FκB, O–cGMP, and opioid receptors support its role in microbiome-relevant pain modulation.

This review highlights lactoferrin’s role as a dual-function immune modulator in microbial infections. It influences inflammation, supports microbiome balance, and enhances barrier integrity, with applications ranging from gut sepsis to respiratory infections and inflammatory diseases.

This review outlines lactoferrin’s dual function in modulating energy metabolism, including glucose control, lipid regulation, and microbiome interaction, positioning it as a safe, multifunctional nutraceutical for managing metabolic disorders.

This review highlights lactoferrin’s potent role in regulating iron metabolism in cancer, reducing oxidative stress, and restoring gut microbiota balance—making it a promising adjunct in oncologic care, especially in managing cancer-related anemia and inflammation.

This review outlines lactoferrin’s potent antioxidant, iron-regulating, and neuroprotective effects across systems. It underscores its therapeutic potential in oxidative stress-related diseases and its modulatory role in microbiome dynamics and host immunity.

This review details how lactoferrin modulates inflammation, recruits immune cells, and bridges innate and adaptive responses—supporting its role as a microbiome-relevant therapeutic agent.

This review highlights lactoferrin’s prebiotic, antimicrobial, and immunomodulatory roles in gut health, showcasing its potential as a therapeutic adjunct for microbiome-targeted interventions, especially in conditions involving dysbiosis and inflammation.

This review highlights lactoferrin’s immunomodulatory role in shaping innate and adaptive responses, with significant implications for neonatal health, microbial defense, and inflammation control. It underlines lactoferrin’s microbiome relevance and clinical potential as a natural immune support agent.

Lactoferrin is a key immunomodulatory glycoprotein that bridges innate and adaptive immunity. It regulates oxidative stress, curbs inflammation, and supports mucosal immune integrity, showing promise for microbiome-focused interventions in infections, IRS, and immune dysfunction.

This review highlights lactoferrin’s role as a biomarker for BD, D, and ED, and evaluates current detection technologies. It emphasizes F’s dual function in host defense and microbiome support.

This review explores lactoferrin’s multifaceted biological roles, emphasizing its ability to shape the microbiome, support immunity, and suppress inflammation and tumors.

This review explores lactoferrin’s biological roles, from microbiome modulation and immune defense to chronic disease and cancer prevention, supporting its use as a multifunctional therapeutic.

This review explores lactoferrin’s protective, antimicrobial, and immunomodulatory roles across life stages, highlighting its impact on the gut microbiome, disease prevention, and aging-related health.

Prebiotic Maltose Gel has emerged as a promising microbiome-targeted therapy for bacterial vaginosis (V), restoring vaginal health by selectively enhancing Lactobacillus populations and suppressing V-associated anaerobes. This dual-action intervention not only validates the gel’s therapeutic efficacy but also confirms the accuracy of V’s microbiome signature as a clinical marker.

Probiotic interventions, particularly those involving Lactobacillus crispatus and Saccharomyces cerevisiae, restore balance to the vaginal microbiome in bacterial vaginosis (V). By reducing dominant anaerobes like Gardnerella vaginalis and promoting recolonization with protective Lactobacillus, these therapies validate both their role as microbiome-targeted interventions (BTIs) and the diagnostic accuracy of the V microbiome signature.

Essential oils (Os) are emerging as powerful microbiome-targeted interventions for biofilm-associated infections (AIs). Backed by preclinical evidence, Os disrupt biofilm formation, reduce inflammation, and restore microbial balance. This validation supports their dual role in treating AIs and confirming the microbiome signature linked to the condition.

Bovine lactoferrin has emerged as a promising microbiome-targeted intervention (BTI) for bacterial vaginosis (V). Clinical and preclinical studies confirm its dual-action ability to restore Lactobacillus dominance and suppress V-associated pathogens like Gardnerella and Prevotella. These microbial shifts, combined with anti-inflammatory effects, validate both the efficacy of bovine lactoferrin and the diagnostic accuracy of the V microbiome signature.

Vitamin C vaginal tablets represent a compelling microbiome-based therapy for recurrent bacterial vaginosis. By restoring vaginal pH and supporting Lactobacillus reestablishment, this intervention validates both its therapeutic role and the microbial signature of V.

Tinidazole is a validated microbiome-targeted therapy for bacterial vaginosis, restoring microbial balance and aligning with diagnostic signatures. It offers better tolerability than metronidazole, with fewer side effects and strong clinical outcomes.

Secnidazole demonstrates dual efficacy in treating bacterial vaginosis by targeting pathogenic anaerobes while preserving beneficial Lactobacillus, validating both its role as a microbiome-based therapeutic intervention (BTI) and the accuracy of V’s microbial signature in guiding effective treatment.

This study confirms secnidazole’s efficacy and safety as a one-dose treatment for V, improving outcomes while supporting microbiome restoration.

Clindamycin is effective in treating bacterial vaginosis by reducing Gardnerella vaginalis and promoting Lactobacillus growth, but recurrence rates highlight the need for adjunct therapies targeting biofilms.

Metronidazole addresses microbial imbalances in bacterial vaginosis by reducing Gardnerella vaginalis and promoting Lactobacillus growth, but biofilm-related resistance may contribute to high recurrence rates. Adjunct therapies are needed for long-term success.

Boric acid restores microbial balance in the vagina by increasing Lactobacillus and reducing harmful species, making it an effective treatment for recurrent V and VC.

This study explores the impact of prebiotic maltose gel on the vaginal microbiota of rhesus macaques, showing its potential to shift microbial balance from V-related bacteria to Lactobacillus dominance, presenting an alternative to antibiotic treatments for bacterial vaginosis.

Boric acid offers promising results for treating resistant vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis. It shows comparable efficacy to oral itraconazole, with fewer adverse events.

This study assesses the impact of metronidazole on the vaginal microbiota, revealing that high G. vaginalis and pathobionts correlate with treatment failure, suggesting a need for biofilm-disrupting therapies in some V patients.

This review discusses bacterial vaginosis, biofilm formation, and emerging therapies targeting biofilms for more effective V treatments.

This review explores the antimicrobial potential of essential oils (Os) in combating microbial biofilms, highlighting their effectiveness against pathogens like S. aureus and C. albicans. Os can serve as an alternative or adjunct to conventional antibiotics, particularly in medical device infections.

This review examines how polymicrobial biofilms contribute to bacterial vaginosis (V) treatment failure and explores alternative strategies for improved therapy.

This study explored the effects of lactoferrin on the vaginal microbiota in women with bacterial vaginosis, showing its potential as a non-antibiotic treatment option.

Bovine lactoferrin shows promise as an adjunctive treatment for bacterial vaginosis, inhibiting metronidazole-resistant G. vaginalis strains and potentiating the effects of clindamycin. Its ability to sequester iron and act synergistically with antibiotics could offer an innovative solution to antibiotic resistance in V.

This study evaluates the efficacy and safety of a single-dose 2% clindamycin vaginal gel for treating bacterial vaginosis, demonstrating significant clinical and bacteriologic cure rates compared to a placebo.

This study compares the microbiological effects of metronidazole and clindamycin in treating bacterial vaginosis, highlighting differences in antimicrobial resistance and efficacy in eliminating V-associated pathogens.

This review assesses the use of tinidazole for treating bacterial vaginosis, comparing its efficacy, side effects, and cost to metronidazole. It highlights tinidazole’s favorable side effect profile and its role in treating recurrent V.

This review evaluates the use of tinidazole in treating bacterial vaginosis, highlighting its efficacy, favorable pharmacokinetics, and reduced side effects compared to metronidazole, especially for recurrent cases.

The study finds that hydrogen peroxide vaginal washout effectively alleviates recurrent bacterial vaginosis symptoms, restoring pH and eliminating pathogens in most cases, though it does not fully restore Lactobacillus populations.

This study demonstrates that 250 mg vitamin C vaginal tablets reduce the recurrence of bacterial vaginosis, offering an effective and safe prophylactic treatment.

The study shows that Lactobacillus crispatus inhibits the growth of Gardnerella vaginalis and Neisseria gonorrhoeae by lowering pH and producing lactic acid, offering insights into microbiome-targeted interventions for bacterial vaginosis and sexually transmitted infections.

This study evaluates the use of intravaginal boric acid for recurrent vulvovaginal candidiasis and bacterial vaginosis, highlighting its long-term tolerability, high patient satisfaction, and rare side effects.

Cannabidiol (BD) shows promise as a microbiome-targeted intervention for bacterial vaginosis (V). It reduces Gardnerella vaginalis viability, disrupts biofilms, and promotes Lactobacillus restoration. BD’s antimicrobial, anti-inflammatory, and antioxidant properties support its effectiveness, reinforcing the V microbiome signature’s clinical accuracy and its potential as a viable treatment option.

This study identifies phospho-2-dehydro-3-deoxyheptonate aldolase as a drug target in Gardnerella vaginalis and highlights five DA-approved compounds as potential treatments for bacterial vaginosis.

This study explores the link between vaginal microbiota and recurrent spontaneous abortion (SA), showing that drug treatment, including metformin combined with aspirin, can alter microbiota composition and potentially improve pregnancy outcomes by increasing Lactobacillus abundance.

This study identifies AHP synthase as a promising drug target for Gardnerella vaginalis in the treatment of bacterial vaginosis, presenting potential inhibitors with favorable pharmacokinetics.

BD shows antibacterial and antibiofilm activity against Gardnerella vaginalis, suggesting its potential as a novel treatment for bacterial vaginosis, particularly in biofilm-related infections.

The study analyzed the genetic evolution of Gardnerella vaginalis, focusing on its resistance and virulence under Darwinian positive selection. It identifies new drug targets and emphasizes the pathogen’s evolving resistance mechanisms.

V disrupts Lactobacillus dominance, increasing infertility risk via inflammation, ID, and endometritis. L. crispatus probiotics reduce V recurrence; E treatment boosts VF success. Early screening and microbiome-targeted therapies are vital to prevent reproductive complications.

Study links V and past chlamydial infection to tubal infertility, with 87.5% of V-positive women having tubal damage. Both infections were often asymptomatic. VF pregnancy rates were unaffected, but V showed lower implantation trends. Findings highlight V’s role in infertility, urging early screening to prevent tubal damage.

This review links V recurrence to resilient biofilms formed by Gardnerella vaginalis. Probiotics and biofilm disruptors (e.g., Astodrimer gel) improve outcomes by restoring Lactobacillus dominance. Current antibiotics fail to penetrate biofilms, necessitating multimodal therapies. Future research should explore MT and microbiome-targeted interventions for sustained V remission.

This study links high pre-treatment vaginal microbiota diversity to V recurrence after metronidazole. Women with sustained clearance had lower richness. Lactobacillus iners improved immune markers temporarily, but no cases achieved L. crispatus dominance. Biofilm-forming taxa like Atopobium persisted, suggesting resistance mechanisms.

This review reveals high V recurrence rates after metronidazole or clindamycin treatment due to microbial biofilms and potential sexual transmission. While both antibiotics show similar short-term efficacy, they differ in resistance patterns. Biofilm disruptors and partner treatment may improve outcomes, but better diagnostics and combination therapies are urgently needed.

This meta-analysis compared V treatments, identifying ornidazole as the most effective oral drug and sucrose/probiotics as top non-antibiotic options. Restoring Lactobacillus dominance is key, with vaginal probiotics and sucrose showing high cure rates.

This review explores the role of vaginal microbiota in bacterial vaginosis and highlights emerging microbiome-informed treatments. It emphasizes microbial signatures of V, the limitations of antibiotics, and the potential of targeted biotherapeutics to restore microbial balance and reduce recurrence.

This systematic review analyzed six trials evaluating secnidazole for bacterial vaginosis treatment. Secnidazole at 2 g significantly improved clinical and microbiologic cure rates, showing comparable efficacy to metronidazole. The single-dose regimen enhances adherence, offering an alternative for patients with recurrent V or adverse effects from standard therapies.

This meta-analysis reviewed 12 randomized controlled trials and found that probiotics significantly improve the clinical cure rate of bacterial vaginosis. Probiotic use restored beneficial Lactobacillus populations and reduced pathogenic bacteria, highlighting their potential as an effective treatment option and adjunct therapy alongside antibiotics.

This study evaluated a Saccharomyces cerevisiae-based probiotic for bacterial vaginosis treatment. The probiotic selectively inhibited V-associated pathogens like G. vaginalis without harming beneficial lactobacilli, offering a microbiome-friendly alternative to antibiotics.

This cross-sectional study identified a strong link between elevated serum lead and cadmium levels and increased risk of bacterial vaginosis. It suggests that heavy metal exposure may disrupt vaginal microbiota stability and immunity, contributing to V susceptibility and pointing to new environmental factors in V prevention strategies.

This study revealed how bacterial vaginosis alters vaginal metabolism, linking specific microbial shifts with distinctive metabolite profiles. It showed that V-associated bacteria drive metabolic changes that increase vaginal pH, disrupt epithelial integrity, and produce characteristic symptoms, offering new diagnostic markers and therapeutic targets.

This review explains how microbial shifts, metabolite production, and immune responses interact in bacterial vaginosis. It highlights the roles of Gardnerella, Atopobium, and other anaerobes in disrupting vaginal health and discusses how their metabolic byproducts and immune modulation drive V symptoms and persistence.

This study used a multi-omic approach to reveal key microbial and metabolic markers of bacterial vaginosis. It identified two distinct symptomatic V metabotypes, each defined by unique microbial and metabolite associations, underscoring the need for metabolomics-informed clinical diagnostics.

This study highlights metabolic interactions between Gardnerella vaginalis and Prevotella bivia, revealing their role in bacterial vaginosis and preterm birth risk. Using MR metabolomics, it identifies acetate as a key metabolite linked to vaginal dysbiosis, offering insights for improving V diagnostics and potential microbiome-targeted interventions.

A nutrient-rich diet lowers bacterial vaginosis (V) risk, while processed foods increase it. This study highlights the importance of dietary choices in vaginal microbiome balance, offering insights for clinicians on how diet influences V risk.

A high glycemic load diet increases bacterial vaginosis (V) risk, while nutrient-rich diets lower it. This study highlights the link between diet quality and vaginal microbiome balance, providing insights for clinicians on how dietary interventions may help prevent V.

A diet high in processed foods and sugar increases bacterial vaginosis (V) risk, while a plant-based diet lowers it. This study highlights the importance of dietary choices in vaginal health, providing insights for clinicians on how nutrition influences the vaginal microbiome.

Higher dietary fat intake increases the risk of bacterial vaginosis (V), while folate, vitamin E, and calcium may lower severe V risk. This study suggests dietary interventions could play a role in managing V, offering insights for clinicians on how nutrition affects vaginal microbiome balance.

The Nugent Score is a standardized Gram stain-based scoring system used to diagnose bacterial vaginosis (V) by assessing key bacterial morphotypes in vaginal samples. With its high specificity, it remains a gold standard in microbiome research, though its complexity and need for trained personnel make it less common in routine clinical practice.

Amsel’s Criteria is a clinically established diagnostic method for bacterial vaginosis, offering a practical and accessible alternative to laboratory-based approaches. It evaluates four key clinical indicators, ensuring timely diagnosis and intervention in outpatient settings.

This study analyzed daily changes in vaginal microbiota before, during, and after V episodes. Findings highlight microbial instability, early dysbiosis markers, and the need for microbiome-focused V treatments.

This study assessed vaginal microbiota in V-positive women using real-time CR. It found reduced Lactobacillus crispatus, biofilm-associated pathogens, and high diagnostic accuracy for molecular testing. Results suggest CR-based diagnostics improve V detection and highlight the need for microbiome-targeted therapies.

This study analyzed vaginal microbiota diversity in women with V using molecular techniques. It identified key V-associated bacteria and emphasized the need for molecular diagnostics and microbiome-targeted therapies.

This study examines vaginal microbiome recovery after metronidazole treatment for V. Findings show delayed microbiota stabilization, L. iners dominance post-treatment, and the need for improved diagnostic tools to predict V recurrence.

This study used high-resolution sequencing to analyze bacterial communities in women with V. Findings reveal distinct microbial associations, diagnostic inconsistencies, and racial differences in V prevalence, highlighting the need for microbiome-targeted therapies and improved diagnostic tools.

This review explores bacterial vaginosis, focusing on microbial imbalances, immune responses, and diagnostic challenges. It highlights the need for microbiome-based treatments and improved diagnostics to reduce recurrence and improve V management.

This study identifies bacterial vaginosis-associated species, improving V diagnostics and treatment strategies through metagenomic sequencing.

This review explores bacterial vaginosis, emphasizing its recurrence, microbial associations, and treatment challenges. It highlights the need for microbiome-based therapies, standardized diagnostic criteria, and potential partner treatment to reduce reinfection. The findings underscore the importance of improved strategies for long-term V management.