Divine Aleru, Microbiome Signatures Research Coordinator

A ketogenic diet restored menstrual cycles and improved pregnancy rates in obese women with COS, even without metformin or ovulation induction. Findings suggest D enhances fertility through metabolic and microbiome-linked pathways beyond weight loss.

A Mediterranean/low-carb diet significantly improved insulin resistance, androgen levels, and weight in overweight COS patients. The findings suggest microbiome-mediated metabolic benefits and support clinical adoption of this dietary model over traditional low-fat diets.

What was reviewed?This overview synthesized evidence from eight systematic reviews and meta-analyses investigating the effects of probiotics, prebiotics, and synbiotics on the management of polycystic ovarian syndrome (COS). The reviews collectively evaluated randomized controlled trials (CTs) focusing on metabolic, hormonal, and inflammatory markers to clarify how microbiota-modulating interventions influence COS-related outcomes. The analysis spanned data […]

A 24-week ketogenic diet significantly reduced insulin resistance, free testosterone, and H/SH ratio in women with COS, improving fertility markers. The dietary intervention may influence gut microbiota, enhancing metabolic and hormonal outcomes.

This study reveals that low fiber and magnesium intake—not overeating or inactivity—contribute significantly to insulin resistance and hyperandrogenism in COS, with strong implications for microbiome-linked interventions.

The study explores how alterations in gut bacteria, fungi, and serum metabolites are linked to polycystic ovary syndrome (COS), revealing potential diagnostic markers and the role of hyperandrogenemia in disease development.

This study reveals significant dysbiosis of gut microbiota in women with COS, particularly in obese individuals. The altered microbial composition correlates with metabolic and hormonal imbalances, offering potential therapeutic targets for improving COS-related conditions.

This study explores the gut microbiota in women with COS and dyslipidemia, revealing significant microbial imbalances associated with lipid metabolism and hormonal dysregulation, offering potential targets for future therapies.

This study shows that gut microbiota dysbiosis in COS correlates with altered serum metabolites, including elevated PCs and reduced citric acid. Roseburia and Prevotella_9 were linked to protective metabolic profiles, while Shigella was associated with inflammation and lipid imbalance.

This study demonstrates that gut dysbiosis in COS is not just correlative but causative. MT and Lactobacillus transplantation restored hormonal balance and ovarian morphology in COS rats, confirming gut microbiota as a viable therapeutic target.

This study reveals disrupted diurnal rhythms and significant dysbiosis in the salivary microbiota of COS patients, notably elevated Fusobacterium and reduced Actinobacteria. These oral microbial patterns may influence systemic metabolic and hormonal dysregulation.

This study reveals that women with COS have altered gut fungal communities, marked by enriched Saccharomyces and depleted Aspergillus. These shifts may contribute to inflammation, metabolic stress, and endocrine disruption, highlighting fungi as critical players in COS pathophysiology.

This review links COS to gut microbiota dysbiosis, showing how PS leakage, CFA deficiency, and altered bile acids contribute to insulin resistance and hyperandrogenism. Microbiome-based therapies, including probiotics, prebiotics, and L-22, show strong promise.

This review presents COS as a multisystem disorder driven by gut dysbiosis, neuroendocrine disruption, and adipose androgen synthesis. Targeting B. vulgatus, L-22, and KR1C3 may offer novel interventions.

This review connects gut microbiota dysbiosis to insulin resistance and hyperandrogenism in COS, identifying reduced CFA producers and increased PS-producing microbes as key signatures. It supports microbiota-targeted therapies as promising treatments for metabolic and reproductive symptoms in COS.

This review introduces the OGMA theory linking gut dysbiosis and leaky gut to insulin resistance, inflammation, and hyperandrogenism in COS. It outlines a compelling rationale for microbiome-targeted therapies using prebiotics and probiotics.

This review links dysbiosis of gut and vaginal microbiota to COS pathogenesis, highlighting reduced Lactobacillus, elevated Bacteroides, and hormonal imbalance. It supports microbiome-targeted therapies like MT and probiotics as promising interventions, emphasizing the role of microbiota in regulating hormones, immunity, and metabolic function.

This Mendelian randomization study identifies a bidirectional causal link between specific gut microbes and COS. Bacilli and Burkholderiales increase COS risk, while Blautia and Cyanobacteria show protective effects. Findings reveal gut microbial signatures that may be targeted for COS treatment.

This study shows reduced gut microbiota diversity and increased ABA-producing bacteria in COS, linking microbial shifts to elevated H levels and supporting a gut–brain axis mechanism. The findings highlight microbial contributions to neuroendocrine dysfunction and suggest therapeutic avenues through microbiome-targeted interventions.

This review explores insulin resistance as a primary driver of COS, detailing molecular signaling defects and their clinical consequences. It provides critical insight into how hyperinsulinemia fuels both metabolic dysfunction and androgen excess, reinforcing COS as a systemic endocrine-metabolic disorder, with implications for microbiome-linked disease signatures.

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.